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Outpatient initiation of long-term continuous positive airway pressure in children

Alessandro Amaddeo1,2,3, Annick Frapin1, Samira Touil1

  • 1Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.

Pediatric Pulmonology
|August 3, 2018
PubMed

Insights

Outpatient initiation of continuous positive airway pressure (CPAP) is feasible for children with obstructive sleep apnea (OSA). This approach demonstrates high compliance and effective treatment, offering a viable alternative to traditional inpatient studies.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Medical Technology

Background:

  • Current guidelines advocate for inpatient titration studies to initiate continuous positive airway pressure (CPAP) in children with obstructive sleep apnea (OSA).
  • Hospital bed shortages and economic factors necessitate alternative approaches for CPAP initiation.
  • Outpatient CPAP programs offer a potential solution to these logistical and financial challenges.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of an outpatient program for initiating CPAP in selected pediatric patients with OSA.
  • To assess CPAP compliance and efficacy in children managed through an outpatient setting.
  • To determine if an outpatient approach can achieve high compliance rates and successful OSA correction.

Main Methods:

  • A prospective program was established for outpatient CPAP initiation in children meeting specific criteria: persistent OSA, age over 6 months, stable condition, and residing in the Parisian area with agreement for regular follow-up.
  • Thirty-one children (median age 8.9 years) with OSA, including those with Down syndrome, achondroplasia, and obesity, were enrolled.
  • CPAP compliance (hours/night and nights/month) and efficacy (apnea-hypopnea index [AHI], gas exchange) were assessed at follow-up.

Main Results:

  • Of 31 children, 27 (87%) achieved good CPAP compliance (median 8:21 hours/night, 25 nights/month).
  • Four subjects (three adolescents with Down syndrome) showed poor compliance (<4 hours/night).
  • In compliant subjects, CPAP was highly effective, with a median post-treatment AHI of 2 events/hour and normal gas exchange. Three children were successfully weaned off CPAP.

Conclusions:

  • Initiating CPAP in an outpatient setting is a feasible and effective strategy for selected children with OSA.
  • The outpatient approach can achieve high patient compliance and successful correction of OSA.
  • This model provides a practical alternative to inpatient titration, addressing resource limitations while ensuring effective treatment.
Abstract

Keywords:
childrencontinuous positive airway pressure (CPAP)obstructive sleep apnea OSAoutpatient

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