Home nasal continuous positive airway pressure in infants with sleep-disordered breathing

Guilleminault, Christian; Pelayo, Rafael; Clerk, Alex; Léger, Damien; Bocian, Robert C.

doi:10.1016/s0022-3476(95)70026-9

Cited by 140 publications

(85 citation statements)

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“…It is very difficult to get young children to wear the PAP apparatus (18,(21)(22)(23). Furthermore, many children requiring PAP therapy have underlying chronic illnesses or developmental delays (2,(16)(17)(18)(19)(20)(21)(22), further complicating efforts to improve adherence. It is therefore imperative to show that PAP use actually improves clinical outcomes in addition to improving polysomnographic abnormalities, before widespread pediatric PAP programs can be advocated.…”

Section: Discussionmentioning

confidence: 99%

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

Marcus

Radcliffe²,

Konstantinopoulou³

et al. 2012

Am J Respir Crit Care Med

150

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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...

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Section: Discussionmentioning

confidence: 99%

“…As is typical for childhood OSAS, where CPAP is usually reserved for children who fail surgical therapy, the study group was heterogeneous, with many children having underlying medical conditions, such as obesity or genetic syndromes (2,(16)(17)(18)(19)(20)(21)(22). Of note, 19% of subjects had developmental delays (Table 1).…”

Section: Study Groupmentioning

confidence: 99%

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

Marcus

Radcliffe²,

Konstantinopoulou³

et al. 2012

Am J Respir Crit Care Med

150

View full text Add to dashboard Cite

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“…4 In these children, continuous positive airway pressure (CPAP) is usually used as the second line of treatment. 5 Although home CPAP use has been reported in Ͼ300 children of all ages, [5][6][7] it is not yet approved by the Food and Drug Administration (FDA) for use in children who weigh Ͻ30 kg. Furthermore, few studies have evaluated the effectiveness of positive airway pressure (PAP) therapy in children, and no prospective studies have evaluated objective measures of adherence in the pediatric age group.…”

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confidence: 99%

Adherence to and Effectiveness of Positive Airway Pressure Therapy in Children With Obstructive Sleep Apnea

et al. 2006

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OBJECTIVES. Positive airway pressure therapy (PAP) is frequently used to treat children who have obstructive sleep apnea syndrome and do not respond to adenotonsillectomy. However, no studies have evaluated objectively adherence to PAP in children, and few studies have evaluated objectively the effectiveness of PAP. The objective of this study was to determine adherence and effectiveness of PAP (both continuous [CPAP] and bilevel [BPAP] pressure) in children with obstructive apnea.METHODS. A prospective, multicenter study was performed of children who were randomly assigned in a double-blind manner to 6 months of CPAP versus BPAP. Adherence was measured objectively using the equipment's computerized output. Effectiveness was evaluated using polysomnography.RESULTS. Twenty-nine children were studied. Approximately one third of children dropped out before 6 months. Of the 21 children for whom 6-month adherence data could be downloaded, the mean nightly use was 5.3 Ϯ 2.5 (SD) hours. Parental assessment of PAP use considerably overestimated actual use. PAP was highly effective, with a reduction in the apnea hypopnea index from 27 Ϯ 32 to 3 Ϯ 5/hour, and an improvement in arterial oxygen saturation nadir from 77 Ϯ 17% to 89 Ϯ 6%. Results were similar for children who received CPAP versus BPAP. Children also had a subjective improvement in daytime sleepiness.CONCLUSIONS. Both CPAP and BPAP are highly efficacious in pediatric obstructive apnea. However, treatment with PAP is associated with a high dropout rate, and even in the adherent children, nightly use is suboptimal considering the long sleep hours in children. T HE OBSTRUCTIVE SLEEP apnea syndrome (OSAS) affects ϳ2% of children. 1 The pathogenesis of childhood OSAS is multifactorial. Contributing factors include anatomic narrowing (as a result of both soft tissue and craniofacial structure) and abnormal upper airway neuromotor control. 2 In most children with OSAS, the primary factor that leads to the upper airway obstruction is adenotonsillar hypertrophy, and OSAS can be treated effectively with tonsillectomy and adenoidectomy. 3 However, in a small number of children in whom additional anatomic factors (including obesity) or abnormal upper airway neuromotor tone is the predominant cause for OSAS, OSAS persists postoperatively. 4 In these children, continuous positive airway pressure (CPAP) is usually used as the second line of treatment. 5 Although home CPAP use has been reported in Ͼ300 children of all ages, 5-7 it is not yet approved by the Food and Drug Administration (FDA) for use in children who weigh Ͻ30 kg. Furthermore, few studies have evaluated the effectiveness of positive airway pressure (PAP) therapy in children, and no prospective studies have evaluated objective measures of adherence in the pediatric age group. We therefore conducted a multicenter, prospective study of PAP therapy in children with OSAS. The objectives of this study were to assess objectively adherence to and effectiveness of PAP in children. In addition, we sought in a r...

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“…13 Auto-CPAP provides variable pressure delivery based on the patient airflow. Instead of providing a constant pressure, such as in CPAP, the device adjusts the pressure during sleep by monitoring the patient's airflow.…”

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confidence: 99%

“…It increases pressure in response to subtle airflow limitation episodes, which precede conventional apneas and hypopneas. 13 The application of variable pressure according to a patient's airflow during sleep may improve comfort and possibly increase treatment compliance. Current Auto-CPAP devices retain in memory information regarding the pressure and airflow events during several nights.…”

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confidence: 99%

Efficacy of Automated Continuous Positive Airway Pressure in Children With Sleep-Related Breathing Disorders in an Attended Setting

2004

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ABSTRACT. Introduction. The purpose of this study was to evaluate the safety and efficacy of automated continuous positive airway pressure (Auto-CPAP) in children.Sleep-related breathing disorders (SRBDs) include the clinical spectrum of symptomatic chronic snoring, upper airway resistance syndrome, and obstructive sleep apnea. This spectrum occurs in adults and children. Less data are available for children despite recognition of the condition's prevalence. CPAP has been an established treatment for adults and children. Treatment with Auto-CPAP has been available for adults but has not been reported previously in children.Methods. A group of 14 children (8 months to 12 years old) was evaluated prospectively with baseline polysomnographic study and CPAP titration performed with Auto-CPAP under sleep technologist supervision.Results. The results demonstrated that Auto-CPAP is sensitive and effective for children with obstructive sleep apnea in an attended setting. There was 1 subject who did not seem to tolerate Auto-CPAP, but when she was switched to conventional CPAP, she did not tolerate that either. In this subject, the mask never fit well. She was excluded from the analysis. All other patients had a decrease in the number of abnormal breathing events during sleep. The respiratory disturbance index decreased from a mean of 12.6 (SD: 12.4) to 2.6 (SD: 2.7) events per hour. The lowest oxygen saturation improved from a mean of 86% (SD: 10.8) to 93.6% (SD: 3.9).Conclusions. We conclude that Auto-CPAP is safe and effective in an attended environment. Auto-CPAP did not eliminate all the abnormal respiratory events. In subjects 1 and 14, the final respiratory index improved but remained >5 events per hour (5.9 and 7.7, respectively). We suspect that this was because of problems with the masks leaking, which illustrates the importance of follow-up and possible need for retitration in some patients. Proper mask fit is essential for successful treatment. Additional work is needed to evaluate its utility in the home setting. This study was designed to evaluate Auto-CPAP titration in an attended environment. It did not indicate information about the effectiveness in an unattended or home setting. We demonstrate that Auto-CPAP is able to detect abnormal breathing events during sleep in children and may provide the necessary pressure to correct these events. Auto-CPAP can be used safely for pressure titration in an attended setting. I n children, sleep-related breathing disorders (SRBDs) are estimated to occur in ϳ2% to 6% of the population. 1 Consequences of SRBDs in children include cardiovascular complications. [2][3][4][5] In addition to the cardiovascular consequences, behavioral changes have been associated with SRBDs and may include irritability, aggressiveness, hyperactivity, and disciplinary problems. Several studies have demonstrated a high incidence of impaired school performance, hyperactivity, decreased intellectual performance, and emotional problems associated with SRBDs in children. 6-9 SRBD symptoms were a...

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Home nasal continuous positive airway pressure in infants with sleep-disordered breathing

Cited by 140 publications

References 15 publications

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

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

Adherence to and Effectiveness of Positive Airway Pressure Therapy in Children With Obstructive Sleep Apnea

Efficacy of Automated Continuous Positive Airway Pressure in Children With Sleep-Related Breathing Disorders in an Attended Setting

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