Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea

Abstract

Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder of breathing during sleep, characterized by intermittent or prolonged upper airway obstruction that can disrupt normal ventilation and/or sleep patterns. It can affect an estimated 2–4% of children worldwide. Untreated OSAS can have far reaching consequences on a child’s health, including low mood and concentration as well as metabolic derangements and pulmonary vascular disease. Most children are treated with surgical intervention (e.g., first-line therapy, adenotonsillectomy); however, for those for whom surgery is not indicated or desired, or for those with postoperative residual OSAS, positive airway pressure (PAP) therapy is often employed. PAP therapy can be used to relieve upper airway obstruction as well as aid in ventilation. PAP therapy is effective in treatment of OSAS in children and adults, although with pediatric patients, additional considerations and limitations exist. Active management and care for various considerations important to pediatric patients with OSAS can allow PAP to be an effective and safe therapy in this population.

Medical Treatment of Obstructive Sleep Apnea in Children

“…Additionally, there are auto-adjusting CPAP/BPAP devices that utilize a unique algorithm. These devices might be useful when the severity of OSA is dependent on body posture and/or sleep stage [56]. CPAP titration with an auto-CPAP device in the home environment can be considered for children when access to a sleep laboratory is limited [57].…”

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

“…A variety of training techniques that include positive reinforcement, gradual exposure to the use of PAP and the use of the equipment in association with pleasurable activities for the child are described in the literature. The current literature does not suggest that any specific desensitization strategy is superior to any other 279 . Regardless of the method, desensitization strategies should be playful in nature.…”

“…Desensitization strategies that help the child to gradually become used to the treatment are indispensable. Strategies involving a multidisciplinary team have been shown to be more effective in increasing tolerance to the use of PAP 279 . A variety of training techniques that include positive reinforcement, gradual exposure to the use of PAP and the use of the equipment in association with pleasurable activities for the child are described in the literature.…”

“…In respect of the pressure to be used, it is suggested that this be titrated in a sleep laboratory. There is lack of studies regarding the use of auto-CPAP in children to determine whether automatic equipment is safe and effective in this population 279 . The use of Bilevel increases the chances of good adherence to treatment 280 .…”

Current Concepts in Pediatric Obstructive Sleep Apnea

“…The predictors for post AT respiratory complications requiring intervention are children with severe OSA particularly AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO 2 ), and poor nutritional status which was shown in a retrospective review conducted by Saeid et al [ 14 ]. For children where surgery is not indicated or desired, or for those with postoperative residual OSAS, positive airway pressure (PAP) therapy can be an effective treatment [ 15 ]. Benke et al study showed that the use of autoCPAP is effective and safe for the treatment of OSAS in pediatric patients with obesity [ 16 ].…”