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Residual sleep disordered breathing under ventilatory support in children: a polysomnography study
Laurianne Coutier1, Sébastien Baillieul2, Aurore Guyon3
1UMR UGA INSERM U1300Laboratoire Hypoxie et Physiopathologies Cardiovasculaires et Respiratoires, Grenoble, France; Service de Pneumologie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Service D'épileptologie Clinique, des Troubles Du Sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Bron, France; Université Claude-Bernard Lyon 1, Lyon, France; Unité INSERM U1028 CNRS UMR 5292, équipe WAKING, Centre de Recherche en neurosciences et Cognition, Université Lyon 1, Lyon, France.
Insights
Long-term ventilatory support (VS) improved sleep apnea symptoms in children, but residual sleepiness and asthenia (RSA) affected 42%. Careful monitoring is crucial for children on VS.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Care
Background:
- Sleep-disordered breathing (SDB) significantly impacts children's health and development.
- Long-term ventilatory support (VS), including continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV), is a common treatment for pediatric SDB.
- Residual symptoms like sleepiness and asthenia (RSA) can persist despite VS.
Purpose of the Study:
- To evaluate the effectiveness of long-term VS on symptoms, sleep, and respiratory parameters in children with SDB.
- To determine the prevalence of RSA in children receiving VS.
- To identify factors associated with RSA in this population.
Main Methods:
- Multicenter retrospective study of 61 children (1 month-18 years) with SDB undergoing VS.
- Polysomnography (PSG) was performed at diagnosis and during VS.
- Clinical, sleep, and respiratory data were compared between diagnostic and VS PSG, and between patients with and without RSA.
Main Results:
- VS significantly improved nighttime SDB symptoms and respiratory parameters, with mild OSA (OAHI 2/hr) during VS.
- However, daytime symptoms were not fully controlled, and 42% of children experienced RSA.
- Children with RSA were more likely to use NIV and had less REM sleep during VS.
Conclusions:
- Long-term VS effectively improves SDB symptoms and respiratory function in children.
- A significant proportion of children on VS experience residual sleepiness and asthenia (RSA).
- Close monitoring during follow-up is essential for children with SDB on VS to manage persistent symptoms.
Objectives:
To assess the effectiveness in children of long-term ventilatory support (VS) (continuous positive airway pressure [CPAP], non-invasive ventilation [NIV]), on symptoms, sleep, respiratory parameters using polysomnography (PSG), evaluate the prevalence of residual sleepiness and/or asthenia (RSA) under VS and identify parameters associated with RSA.
Methods:
Multicenter retrospective study including children with SDB aged between 1 month and 18 years, under long-term VS, evaluated by PSG, both at diagnosis in room air and under VS. Clinical, sleep, and respiratory characteristics were compared between diagnostic PSG and PSG under VS for the entire cohort and between patients with and without RSA.
Results:
A total of 61 children were included (median [IQR] age at diagnostic PSG and at PSG under VS, 7 [0-13] and 8 [0-13] years respectively). While the SDB night-time symptoms significantly improved with VS, the SDB daytime symptoms were not all well controlled; RSA under VS was present in 22/53 (42%) children. At PSG under VS compared to diagnostic PSG, non-respiratory arousal index remained abnormal despite significant improvement (median n = 15/hr [8-23] versus 21/h [12-29], p = 0.009) and OSA became mild (median OAHI 2/hr [1-4] versus 13/h [6-27], p < 0.001). Children with RSA, compared to children without RSA, more frequently used NIV than CPAP (82% versus 18%, p < 0.01) and had a lower proportion of rapid eye movement under VS (18% [14-25] versus 24% [20-32], p = 0.038).
Conclusion:
While SDB symptoms improved under VS concurrent with the respiratory parameters, a significant proportion of children remained symptomatic with RSA, underlying the importance of carefully monitoring these patients during follow-up.
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