Comparison of non-invasive ventilation use and outcomes in children with Down syndrome and other children using this

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Rafiaa Valji1, Maria L Castro-Codesal1, Melanie Lewis2,3

  • 1Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Frontiers in Sleep
|December 22, 2025
PubMed

Insights

Long-term non-invasive ventilation (LT-NIV) is effective for children with Down syndrome (DS), primarily for upper airway obstruction. Despite lower adherence, most children with DS successfully use LT-NIV.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Genetics

Background:

  • Children with Down syndrome (DS) are significant users of long-term non-invasive ventilation (LT-NIV).
  • Unique physiological characteristics in DS may impact LT-NIV efficacy and usage patterns.
  • Understanding these differences is crucial for optimizing respiratory support in this population.

Purpose of the Study:

  • To compare the utilization and outcomes of LT-NIV in pediatric patients with DS versus a matched comparison group (MCG).
  • To investigate the efficacy and adherence patterns of LT-NIV in children with DS.
  • To identify specific indications and treatment modalities for LT-NIV in children with DS.

Main Methods:

  • A retrospective review of 622 children initiated on LT-NIV in Alberta, Canada.
  • 106 children with DS were matched 1:2 with MCG based on age and therapy start date.
  • Data extracted from medical and sleep laboratory records.

Main Results:

  • Upper airway disease was the primary indication for LT-NIV, significantly higher in the DS group (90% vs. 50%).
  • Continuous positive airway pressure (CPAP) was more frequently used in children with DS (93.3% vs. 69.2%).
  • Adherence was lower in the DS group, yet a majority used LT-NIV for over 4 hours nightly; discontinuation and mortality rates did not differ.

Conclusions:

  • LT-NIV is an effective treatment for children with DS, particularly for upper airway obstruction.
  • While adherence challenges exist, most children with DS achieve successful LT-NIV use.
  • Further research may explore strategies to improve adherence in this population.
Abstract

Keywords:
bilevel positive airway pressurecontinuous positive airway pressureobstructive sleep apneapediatrictrisomy 21

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