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Obstructive sleep apnea: the use of nasal CPAP in 80 children
K A Waters1, F M Everett, J W Bruderer
1David Read Sleep Disorders Unit, University of Syndey, Australia.
Insights
Nasal mask continuous positive airway pressure (nCPAP) effectively treated obstructive sleep apnea (OSA) in children, with 90% showing symptom resolution. This therapy is generally well-tolerated in pediatric patients with OSA.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) affects children, necessitating effective treatment options.
- Adenotonsillectomy and nasal mask continuous positive airway pressure (nCPAP) are common interventions for pediatric OSA.
Purpose of the Study:
- To evaluate the efficacy and tolerance of nCPAP therapy for obstructive sleep apnea in children.
- To compare patient characteristics between nCPAP and adenotonsillectomy treatment groups.
Main Methods:
- Retrospective review of 413 children (≤15 years) diagnosed with OSA between 1980-1993.
- Analysis of treatment outcomes for children receiving adenotonsillectomy (n=175) versus nCPAP (n=80).
- Assessment of patient demographics, comorbidities, and nCPAP efficacy (duration, pressure, respiratory disturbance index).
Main Results:
- nCPAP therapy eliminated OSA signs in 90% of treated children (72/80).
- The mean respiratory disturbance index significantly decreased from 27.3 to 2.55 (p < 0.001) with nCPAP.
- Children receiving nCPAP had a higher prevalence of congenital syndromes or malformations (53%) compared to the overall OSA group (27.7%).
- Male predominance was observed in both the overall study group (69%) and the nCPAP group (71%).
Conclusions:
- nCPAP is an effective and generally well-tolerated treatment for obstructive sleep apnea in infants and children.
- Children with congenital syndromes or malformations may benefit from nCPAP therapy.
- While effective, some children may experience intolerance to higher nCPAP pressures due to hypoventilation or central apneas.
Abstract:
This is a retrospective review of children 15 years of age or younger, who underwent overnight sleep studies between 1980 and 1993. All were diagnosed and treated for obstructive sleep apnea (OSA). Overnight studies were performed for OSA in 413 children. One hundred seventy-five (42.4%) children were treated with adenotonsillectomy and 80 (19.4%) with nasal mask continuous positive airway pressure (nCPAP). The proportion of male children was greater than expected in both the entire study group (69%, p < 0.001) and in those treated with nCPAP for OSA (71% p < 0.001). There was no significant difference between the mean age of the children treated with nCPAP (5.7 +/- 0.5 yr) and the entire group studied (5.04 +/- 0.21 yr). A greater proportion of the children who received nCPAP therapy had a congenital syndrome or malformation than in the group with OSA as a whole; 27.7% of children assessed for OSA were affected, and 53% of those children with OSA who received treatment with nCPAP (p < 0.001). Therapy with nCPAP (mean duration 15 +/- 3 mo, mean pressure 7.9 cm H2O) eliminated the signs of OSA in 72 children (90%). Respiratory disturbance index fell from a mean of 27.3 +/- 20.2 to 2.55 +/- 2.74 (p < 0.001). Eight of 32 children who underwent pressure determination studies could not tolerate nCPAP above an upper limit because of hypoventilation or frequent central apneas. Nevertheless, we conclude that nCPAP is an effective and generally well-tolerated therapy for treatment of OSA in infants and children.