Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea

doi:10.1016/S0022-3476(95)70262-8

The Journal of Pediatrics

Volume 127, Issue 1, July 1995, Pages 88-94

Presented in part at the annual meeting of the American Thoracic Society, Boston, Mass., May 1994.

https://doi.org/10.1016/S0022-3476(95)70262-8 Get rights and content

Abstract

Objective: To determine the safety and efficacy of nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) during childhood and the effects of growth and maturation on CPAP requirements. Design: Retrospective study with use of a written questionnaire administered to pediatric practitioners treating sleep disorders. Setting: Nine academic pediatric sleep disorders centers. Results: Data were obtained for 94 patients. Three percent of patients receiving CPAP were less than 1 year, 29% were 1 to 5 years, 36% were 6 to 12 years, and 32% were 13 to 19 years of age; 64% were boys. The longest duration of CPAP use was 4 years. Indications for CPAP included OSA associated with obesity (27%), craniofacial anomalies (25%), idiopathic OSA persisting after adenoidectomy and tonsillectomy (17%), and trisomy 21 (13%). Continuous positive airway pressure was effective in 81 patients (86%), in one patient it was unsuccessful, and in 12 patients compliance was inadequate. The median pressure required was 8 cm H₂O (range, 4 to 20 cm H₂O); pressure requirements were independent of age or diagnosis. Twenty-two percent of patients eventually required a modification of CPAP levels. Complications of CPAP were minor. Sixty-four percent of centers reported difficulty in obtaining funding for CPAP. Conclusions: Continuous positive airway pressure is safe, effective, and well tolerated by children and adolescents with OSA. Experience in infants is limited. As pressure requirements change with patient growth, we recommend that CPAP requirements be regularly reevaluated over time. The marked center-to-center variability in CPAP use suggests that specific indications for this therapy require clarification. (J PEDIATR 1995;127:88-94)

Section snippets

METHODS

Retrospective data on the use of CPAP in children were obtained from detailed questionnaires sent to 11 major pediatric sleep disorder centers (nine in the United States, one in Canada, and one in France). The questionnaires were answered by the medical directors. When necessary, further information was obtained by telephone. Patients using CPAP or bilevel positive airway pressure (BiPAP, Respironics Inc., Murrysville, Pa.) (which provides different levels of inspiratory and expiratory

RESULTS

Responses were received from nine of the 11 centers. The remaining two centers were unable to furnish detailed information because of lack of records and were therefore not included in the study. Of these two centers, one reported following only a few patients; the other stated that it followed a large group of patients but could not provide exact numbers.

DISCUSSION

The combined experience of a number of major pediatric sleep disorder centers has shown that CPAP is safe and well tolerated by children and adolescents with OSA. The lack of persistent complications of OSA in this population and the small number of patients undergoing tracheostomy indicate that CPAP therapy is efficacious in the pediatric age group.

Continuous positive airway pressure has become available only recently; its first reported use was in 1981.¹³ Because of the relatively small

Acknowledgements

We thank Kathleen Bukowski for secretarial assistance. We also thank the many colleagues who assisted us in the preparation of this manuscript and in the clinical care of the patients, especially John Carroll, MD; G. Michael Davis, MBChB; Claude Gaultier, MD; Gerald M. Loughlin, MD; Jean M. Silvestri, MD; and Shelley Curtis, RN.

References (20)

RT Brouillette et al.
Obstructive sleep apnea in infants and children
J PEDIATR
(1982)
CE Sullivan et al.
Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares
Lancet
(1981)
MJ Miller et al.
Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants
J PEDIATR
(1985)
C Guilleminault et al.
Obstructive sleep apnea and near miss for SIDS: report of an infant with sudden death
Pediatrics
(1979)
C Guilleminault et al.
A review of 50 children with obstructive sleep apnea
Lung
(1981)
CE Sullivan et al.
Continuous positive airway pressure in sleep-disordered breathing
C Guilleminault et al.
Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children
Pediatrics
(1986)
WW Schmidt-Nowara
Continuous positive airway pressure for long-term treatment of sleep apnea
Am J Dis Child
(1984)
CF Ryan et al.
Nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea in Hallermann-Streiff syndrome
Clin Pediatr
(1990)
R Downey et al.
Obstructive sleep apnea in children: the efficacy of nasal continuous positive airway pressure [Abstract]
Sleep Res
(1991)

There are more references available in the full text version of this article.

Cited by (251)

Integrative traditional Chinese medicine treatment for children with obstructive sleep apnea
2024, Journal of Traditional and Complementary Medicine
Obstructive sleep apnea (OSA) is a chronic disease that affects 1%–6% of children. Our study aims to explore the effectiveness and clinical characteristics of integrative Traditional Chinese Medicine (ITCM) for pediatric OSA.
In this retrospective cohort study, we assessed differences of polysomnography (PSG) parameters and clinical characteristics between 2009 and 2020. Children <12 years old diagnosed with OSA (n = 508) were included and were categorized into ITCM cohort, western medicine (WM) cohort ,and surgery cohort. Outcomes were apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and body mass index (BMI).
There were 56 (11%), 324 (63.8%), and 128 (25.2%) patients in the ITCM, WM, and surgery cohorts. Among 17, 26, and 33 patients in the ITCM, WM, and surgery cohorts underwent follow-up PSG studies, respectively. In the ITCM follow-up cohort, AHI were significantly reduced (9.59 to 5.71, p < 0.05). BMI significantly increased in the WM follow-up cohort (19.46 to 20.50, p < 0.05) and the surgery follow-up cohort (18.04 to 18.85, p < 0.01). Comparing ITCM to WM cohort, a significant difference was found between the changes in RDI (ITCM: −6.78, WM: 0.51, p < 0.05) after treatment. Among ITCM follow-up cohort, the most prescribed TCM formula was Forsythia and Laminaria Combination. The most prescribed TCM herb was Ephedrae Herba.
ITCM therapy can significantly reduce RDI and control BMI. We identified potential TCM treatments for pediatric OSA. Further study of the pharmacological mechanisms and clinical efficacy is warranted.
Pediatric obesity education and counseling in otolaryngology clinics: A survey of ASPO members
2023, International Journal of Pediatric Otorhinolaryngology
Adenotonsillectomy can cure pediatric obstructive sleep apnea (OSA) in 80% of children without obesity but only 20–30% of children with obesity. Despite this, there is a current lack of consistent guidelines and practices around pediatric obesity management in otolaryngology. This study evaluated the extent of counseling, referrals, confidence, and barriers in addressing childhood obesity in pediatric otolaryngology.
A 20-question electronic survey assessing pediatric obesity practice patterns regarding sleep-disordered breathing (SDB) and OSA was distributed to all American Society of Pediatric Otolaryngology (ASPO) members. Descriptive statistics were performed. Pediatric otolaryngologists were compared using logistic regression models based on their practice type and frequency of counseling and referral.
Of all ASPO members, 19.6% (114/583) completed the survey. Half (50.0%) of physicians counsel and 14.0% refer to obesity management >75% of the time. Only 8.8% of physicians are confident their counseling helps reduce their patient's obesity, and 35.9% of physicians are satisfied with their services available for referral. Most physicians cite time/clinical workload (81.6%) and parent/rearing habits (50.0%) as barriers to obesity counseling. Non-academic physicians had lower odds of counseling and referring their patients >50% of the time (aOR 0.23 [95%CI 0.06–0.81], aOR 0.23 [95%CI 0.06–0.83]). Almost all (92.1%) physicians counsel on residual SDB or OSA after adenotonsillectomy >75% of the time if the child is obese.
Most pediatric otolaryngologists do not regularly counsel or refer patients to available obesity management programs, with differences seen between academic and non-academic surgeons. Confidence is low in currently available measures to reduce pediatric obesity. These results highlight the challenges of pediatric obesity and provide context for guideline implementation and additional resource development for pediatric otolaryngologists.
Hypoglossal nerve stimulation
2023, Snoring and Obstructive Sleep Apnea in Children
Since the first attempts to relieve upper airway obstruction by electrical stimulation of the upper airway musculature in animal models, and later, in humans, treatment of complex obstructive sleep apnea using hypoglossal nerve (HGN) stimulation has come a long way. Once thought to be beneficial in adults, HGN has now been approved in some children. Innovations in stimulation interfaces and surgical refinements have established the safety and efficacy of this promising technique. This chapter describes the experiences of a surgical team in setting up a successful HGN program.
Sleep in children with genetic disorders
2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second Edition
Sleep issues are common in children with genetic disorders and contribute to their symptom burden. Genetic disorders present unique opportunities for elucidating mechanisms that underlie sleep disturbances. Integration of basic science, translational, and clinical research on genetic disorders facilitates an enhanced understanding of their associated sleep issues and development of targeted treatments. Particular genetic disorders will be discussed including Down syndrome, sickle cell disease, mucopolysaccharidoses, craniofacial syndromes, Wolfram syndrome, Smith-Magenis syndrome, Angelman syndrome, Prader-Willi syndrome, CHARGE syndrome, Williams syndrome, Niemann-Pick disease type C, Rett syndrome, Fragile X syndrome, tuberous sclerosis, and neurofibromatosis type 1.
Continuous Positive Airway Pressure Use for Obstructive Sleep Apnea in Pediatric Patients
2022, Sleep Medicine Clinics
Citation Excerpt :
There is limited evidence of the efficacy comparisons between CPAP and high-flow nasal cannula. As with adults on CPAP, children using CPAP frequently experience nasal bridge sores from masks, abdominal distention, mouth and nasal/pharyngeal dryness, nasal congestion, rhinorrhea, epistaxis, eye irritation, and overall discomfort from air leaks, especially in the setting of a poorly fitting mask.13,24,44 These side effects can affect at least 30% of children after 5 months of use.52
Computational assessment of upper airway muscular activity in obstructive sleep apnea – In vitro validation
2022, Journal of Biomechanics
Citation Excerpt :
Therefore, many factors that undermine airway patency are targets of OSA treatment. Treatment options include hypoglossal nerve stimulation of upper airway musculature (Strollo et al., 2014), surgical changes to address abnormal airway anatomy (Epstein et al., 2009; Marcus et al., 2012), and application of continuous positive airway pressure (CPAP) to pneumatically stent the upper airway open (Jordan et al., 2014; Marcus et al., 1995; Patil et al., 2019). Upper airway surgery is often a promising option, offering the possibility of OSA resolution postoperatively.
Neuromuscular control of the upper airway contributes to obstructive sleep apnea (OSA). An accurate, non-invasive method to assess neuromuscular function is needed to improve surgical treatment outcomes. Currently, surgical approaches for OSA are based on airway anatomy and are often not curative. When the airway surface moves, the power transferred between air in the airway lumen and the structures of the upper airway may be a measure of airway neuromuscular activity. The aim of this study was to validate power transfer as a measure of externally applied forces, representing neuromuscular activity, through cine computed tomography (CT) imaging and computational fluid dynamics (CFD) analysis in a 3D-printed airway model. A hollow elastic airway model was manufactured. An insufflation/exsufflation device generated airflow within the model lumen. The model was contained in an airtight chamber that could be positively or negatively pressurized to represent muscular forces. These forces were systematically applied to dilate and collapse the model. Cine CT imaging captured airway wall movement during respiratory cycles with and without externally applied forces. Power transfer was calculated from the product of wall movement and internal aerodynamic pressure forces using CFD simulations. Cross-correlation peaks between power transfer and changes in externally applied pressure during exhalation and inhalation were −0.79 and 0.95, respectively. Power transfer calculated via cine CT imaging and CFD was an accurate surrogate measure of externally applied forces representing airway muscular activity. In the future, power transfer may be used in clinical practice to phenotype patients with OSA and select personalized therapies.

View all citing articles on Scopus

^☆: From Johns Hopkins University, Baltimore, Maryland; Childrens Hospital Los Angeles, Los Angeles, California; St. Louis Children's Hospital, St. Louis, Missouri; Yale University School of Medicine, New Haven, Connecticut; Tulane University Medical Center, New Orleans, Louisiana; Rush Presbyterian-St. Luke's Medical Center, Rush University, Chicago, Illinois; McGill University, Montreal, Quebec, Canada; Hôpital Antoine Beclere, Clamart, France; and Rainbow Babies and Childrens Hospital, Cleveland, Ohio

^☆☆: Supported in part by Clinical Associate Physician grant RR-00052, Pediatric Clinical Research Center, Johns Hopkins Hospital, Baltimore, Md., and by an American Lung Association of Maryland research grant (Dr. Marcus).

^★: Reprint requests: Carole L. Marcus, MBBCh, Johns Hopkins Hospital, Eudowood Division of Pediatric Respiratory Sciences, Park 316, 600 N. Wolfe St., Baltimore, MD 21287-2533.

^★★: 0022-3476/95/$3.00 + 0 9/20/63773

View full text

Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea☆,☆☆,★,★★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Acknowledgements

J PEDIATR

Lancet

J PEDIATR

Obstructive sleep apnea and near miss for SIDS: report of an infant with sudden death

Pediatrics

A review of 50 children with obstructive sleep apnea

Lung

Continuous positive airway pressure in sleep-disordered breathing

Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children

Pediatrics

Continuous positive airway pressure for long-term treatment of sleep apnea

Am J Dis Child

Nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea in Hallermann-Streiff syndrome

Clin Pediatr

Obstructive sleep apnea in children: the efficacy of nasal continuous positive airway pressure [Abstract]

Sleep Res