Effects of Positive Airway Pressure Therapy on Neurobehavioral Outcomes in Children with Obstructive Sleep Apnea

Abstract

Rationale: Positive airway pressure therapy is frequently used to treat obstructive sleep apnea in children. However, it is not known whether positive airway pressure therapy results in improvements in the neurobehavioral abnormalities associated with childhood sleep apnea. Objectives: We hypothesized that positive airway pressure therapy would be associated with improvements in attention, sleepiness, behavior, and quality of life, and that changes would be associated with therapy adherence. Methods: Neurobehavioral assessments were performed at baseline and after 3 months of positive airway pressure therapy in a heterogeneous group of 52 children and adolescents. Measurements and Main Results: Adherence varied widely (mean use, 170 6 145 [SD] minutes per night). Positive airway pressure therapy was associated with significant improvements in attention deficits (P , 0.001); sleepiness on the Epworth Sleepiness Scale (P , 0.001); behavior (P , 0.001); and caregiver-(P ¼ 0.005) and child-(P , 0.001) reported quality of life. There was a significant correlation between the decrease in Epworth Sleepiness Scale at 3 months and adherence (r ¼ 0.411; P ¼ 0.006), but not between other behavioral outcomes and adherence. Behavioral factors also improved in the subset of children with developmental delays. Conclusions: These results indicate that, despite suboptimal adherence use, there was significant improvement in neurobehavioral function in children after 3 months of positive airway pressure therapy, even in developmentally delayed children. The implications for improved family, social, and school function are substantial. Clinical trial registered with www.clinicaltrials.gov (NCT 00458406).Keywords: continuous positive airway pressure; obstructive sleep apnea; sleepinessThe obstructive sleep apnea syndrome (OSAS) affects up to 4% of children (1). In most children, OSAS is associated with adenotonsillar hypertrophy, and improves after adenotonsillectomy (2). However, a significant proportion of children have residual OSAS postoperatively (3). Furthermore, many children with OSAS have other underlying conditions, such as obesity or Down syndrome. In these children, continuous positive airway pressure (CPAP) is usually used as the second line of treatment (2). Although CPAP is now being used commonly in children, only a handful of studies have evaluated its efficacy.If left untreated, OSAS may lead to substantial comorbidities. In particular, childhood OSAS has been shown to be associated with behavioral disturbances and learning deficits (4). The effect of PAP therapy in treating these neurobehavioral deficits in children is unknown. We therefore prospectively evaluated changes in neurobehavioral parameters, including symptoms of attentiondeficit/hyperactivity disorder (ADHD), sleepiness, behavior, and quality of life, at baseline and after 3 months of PAP in children with OSAS. We hypothesized that children treated effectively with PAP, including children with developmental delays, would show improvements in neurobehav...

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…Literature review a) Indications for CPAP and NPPV are described in class IV studies [234][235][236][237][238][239]. b) In two class III controlled trials, positive effects of CPAP and NPPV on neurobehavioural outcomes, school performance and quality of life were demonstrated [236,240].…”

Correlates of Pediatric CPAP Adherence

“…Hawkins, MD 1,2 ; Emily L. Jensen, BS 3,4 may result in development of the aforementioned comorbidities, compromised daily functioning, increased health care utilization, and contribution to early mortality. 6,[15][16][17][18][19][20][21][22][23] OSA severity, pressure settings, and mask type, have not been found to affect use, 14,[24][25][26][27][28][29][30] whereas psychosocial factors and perception of OSA's importance do.…”

“…1 Adverse outcomes associated with pediatric OSA include neurobehavioral, cardiovascular, metabolic, and growth abnormalities, which contribute to decreased social functioning and quality of life; successful and consistent treatment is associated with reduction of morbidity, including improvement of daytime symptoms and neurobehavioral parameters. [2][3][4][5][6][7] First-line therapy for children entails optimization of airway patency by adenotonsillectomy (AT). 1 Overall surgical intervention is successful in 79% of patients, however those with severe OSA, obesity, and additional risk factors, such as genetic syndromes are less likely to be cured by AT alone.…”

Current Treatment of Selected Pediatric Sleep Disorders

“…Recent data indicates that even with suboptimal use, CPAP confers benefits in neurobehavioral outcomes in children with OSA [53]. However, while PAP is effective in lowering AHI and may be associated with improvements in domains of interest, it remains challenging due to adherence related concerns.…”