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Published on: May 11, 2015
Continuous positive airway pressure improves work of breathing in pediatric chronic heart failure
Alessandro Amaddeo1, Diala Khraiche2, Sonia Khirani3
1Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades F-75015, Paris, France; Université de Paris, VIFASOM F-75004, Paris, France.
Insights
Sleep disordered breathing (SDB) is uncommon in children with chronic heart failure (CHF). Continuous positive airway pressure (CPAP) can decrease work of breathing and respiratory rate without negatively impacting cardiac index in these young patients.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Critical Care
Background:
- Sleep disordered breathing (SDB) is prevalent in adults with chronic heart failure (CHF).
- The prevalence and impact of SDB in pediatric patients with CHF are not well understood.
- Continuous positive airway pressure (CPAP) is a treatment for SDB, but potential adverse hemodynamic effects warrant investigation in children.
Purpose of the Study:
- To investigate the prevalence of SDB in children with CHF.
- To evaluate the effects of CPAP on work of breathing (WOB) and cardiac index (CI) in this population.
Main Methods:
- Prospective analysis of SDB in children (6 months–18 years) with CHF.
- Inclusion criteria: dilated cardiomyopathy (EF < 45%), functional single ventricle, or valve disease awaiting surgery.
- Polysomnography (PSG) and measurements of WOB and CI during spontaneous breathing and CPAP (6, 8, 10 cmH2O).
Main Results:
- Thirty pediatric patients (mean age 6.4 ± 5 years) were included.
- Most patients (73%) had normal sleep efficiency; median apnea-hypopnea index (AHI) was 1.6 events/h.
- CPAP significantly decreased WOB (p=0.05) and respiratory rate (p=0.01) without adverse effects on CI.
Conclusions:
- Severe SDB is uncommon in children with CHF.
- CPAP may be a beneficial treatment for SDB in pediatric CHF patients.
- CPAP effectively reduces WOB and respiratory rate without compromising cardiac function.
Background:
Sleep disordered breathing (SDB) is common in adults with chronic heart failure (CHF), but its prevalence in children remains unclear. Continuous positive airway pressure (CPAP) is the treatment of SDB but deleterious hemodynamic effects have been reported.
Methods:
We prospectively analyzed SDB in children with CHF and the effect of CPAP on work of breathing (WOB) and cardiac index (CI). Children aged 6 months to 18 years old with CHF due to: 1) dilated cardiomyopathy (DM) with an ejection fraction < 45%, 2) functional single ventricle (SV) or 3) aortic or mitral valve disease awaiting surgery (VD) were eligible for the study. A polysomnography (PSG), measurement of WOB and CI during spontaneous breathing (SB) and CPAP (6, 8 and 10 cmH2O) were performed.
Results:
Thirty patients with mean age of 6.4 ± 5 years were included (16 DM 16, 10 SV, 4 LV). Twenty (73%) patients had a normal sleep efficiency. Median apnoeas hypopnea index (IAH) was within normal range at 1.6 events/h (0, 14) events/hour. Only one patient had central sleep apnoeas, none had Cheyne-Stokes respiration, and 3 patients had an obstructive AHI between 5 and 10 events/hour. Optimal CPAP level decreased WOB (p = 0.05) and respiratory rate (p = 0.01).
Conclusions:
Severe SDB was uncommon in children with CHF. However, CPAP may be beneficial by decreasing WOB and respiratory rate without deleterious effects on CI.
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