Ventilatory management of sleep-disordered breathing in children

The purpose of this review is to summarize the current management of continuous positive airway pressure and noninvasive positive pressure ventilation in children with sleep-disordered breathing.

Although most children with sleep-disordered breathing respond to surgical treatment, the use of continuous positive airway pressure and noninvasive positive pressure ventilation in nonresponders has become common, with hundreds of cases reported in the literature, despite the fact that these devices are not approved by the Food and Drug Administration for use in children weighing under 30 kg. Studies show that continuous positive airway pressure and non-invasive positive pressure ventilation are safe and efficacious. Side-effects are minor, and include nasal symptoms and skin breakdown. Midfacial hypoplasia is an uncommon adverse event. Problems with triggering and cycling of noninvasive positive pressure ventilation remain an issue in small or weak children. As in adults, poor adherence is the major obstacle to successful continuous positive airway pressure or noninvasive positive pressure ventilation use.

Continuous positive airway pressure is a useful second-line treatment for children with sleep-disordered breathing. Strategies to improve adherence are needed. Equipment manufacturers should be encouraged to develop equipment that better meets children's needs.