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Long term noninvasive respiratory support in children with OSA-I and OSA-II: Data of a nation-wide study

Chiara Tommesani1, Sonia Khirani2, Alessandro Amaddeo3

  • 1Post Graduate School of Pediatric, Università Milano Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, MI, Italy; Department of Pediatrics, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France.

Sleep Medicine
|December 6, 2024
PubMed

Insights

Children with obstructive sleep apnea (OSA) and obesity (OSA-II) were older at continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) initiation and received longer treatment than children with OSA alone (OSA-I). Both groups showed comparable compliance.

Area of Science:

  • Pediatric pulmonology
  • Sleep medicine
  • Respiratory care

Background:

  • Obstructive sleep apnea (OSA) is a prevalent sleep disorder in children.
  • Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are common treatments for pediatric OSA.
  • Understanding treatment characteristics in different pediatric OSA populations is crucial for optimizing care.

Purpose of the Study:

  • To analyze characteristics of children with OSA alone (OSA-I) versus those with OSA and non-syndromic obesity (OSA-II).
  • To compare long-term CPAP/NIV treatment parameters in these pediatric OSA groups.
  • To evaluate initiation criteria, duration, equipment, settings, and compliance in France in 2019.

Main Methods:

  • Retrospective analysis of a national survey on pediatric home ventilatory support in France.
  • Inclusion of children with OSA-I and OSA-II treated with CPAP/NIV.
  • Analysis of demographic data, treatment initiation criteria (apnea-hypopnea index, gas exchange), treatment duration, CPAP/NIV settings, mask type, and objective compliance.

Main Results:

  • OSA-II patients constituted 10% of the cohort, while OSA-I patients were 6%.
  • OSA-II patients were significantly older at CPAP/NIV initiation (11.0 vs 6.8 years) and received longer treatment durations (2.3 vs 1.3 years).
  • NIV use was slightly higher in OSA-II (13% vs 6%), mean CPAP levels were higher in OSA-II (8.7 vs 7.7 cmH2O), and objective compliance was comparable between groups.

Conclusions:

  • Children with OSA and obesity (OSA-II) represent a significant proportion of pediatric patients requiring long-term CPAP/NIV.
  • OSA-II patients are older at treatment initiation and require longer treatment durations compared to OSA-I patients.
  • Treatment approaches, including CPAP levels and mask preferences, show some differences, but compliance is similar, highlighting the need for tailored management strategies.
Abstract

Keywords:
Noninvasive respiratory supportObesityObstructive sleep apnea

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