Nasal Continuous Positive Airway Pressure Use In Children With Obstructive Sleep Apnea Younger Than 2 Years of Age

doi:10.1378/chest.117.6.1608

Chest

Volume 117, Issue 6, June 2000, Pages 1608-1612

https://doi.org/10.1378/chest.117.6.1608 Get rights and content

Study objectives

To assess the efficacy of continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients who are < 2 years of age.

Design

A retrospective chart review of 18 patients from 1992 to 1999 who had OSA confirmed by polysomnography. All patients in this study also completed a separate night of CPAP polysomnography to determine the effectiveness of CPAP in the correction of OSA. Nasal CPAP compliance data were gathered via clinical follow-up examination, telephone interview, or mailed questionnaire.

Setting

All patients were studied in the Sleep Disorders Center at Loma Linda University Children's Hospital in Loma Linda, CA.

Patients

All patients were < 2 years old.

Intervention

After OSA was confirmed by the results of technician-attended nocturnal polysomnography, separate technician-attended nocturnal CPAP polysomnography was completed. On CPAP nights, CPAP pressure was titrated to ameliorate OSA and snoring. CPAP pressure was increased by 2-cm H₂O or 1-cm H₂O increments.

Results

Data were analyzed by dependent groups t test at p < 0.05 level of significance. CPAP statistically improved respiratory parameters significantly when compared to baseline polysomnography. The following four patient subgroups emerged from the analysis: group 1 consisted of six patients who had tracheostomies prior to the CPAP trial, with two patients using CPAP as an alternative to tracheostomy; group 2 consisted of two patients who had previous unsuccessful adenostonsillectomies and who used CPAP successfully, with both having OSA resolution over time; group 3 consisted of four patients who did not tolerate CPAP on the study night; and group 4 consisted of six patients who used CPAP nightly, had OSA resolution over time, and therefore, no longer needed CPAP therapy. Thus, 10 of 18 patients used CPAP either on an interim basis for corrective therapy or as a primary treatment modality for OSA.

Conclusions

These data show that children < 2 years of age can tolerate and use CPAP effectively. In several cases, CPAP treatment could be discontinued as OSA resolved over time. The reasons for this are discussed in the text.

Section snippets

Materials and Methods

We retrospectively examined the last 18 patients < 2 years of age who had received a diagnosis of OSA by standard clinical polysomnography and who consented to the use of nasal CPAP as an elective treatment for their OSA. If a correctable cause of OSA was not considered as an effective alternative at the time of evaluation, CPAP was presented to the parents and referring physicians as an alternative treatment for OSA.

All polysomnography was completed using a polysomnograph (model 78D; Grass;

Results

All patients were < 2 years of age at the time of the initial CPAP study; 11 patients were < 1 year of age, and 7 patients were between 1 and 2 years of age.

The studied children had a variety of medical disorders that were thought to be contributing factors to their OSA. Patient diagnoses and final known dispositions are listed in Tables 1 and 2 .

Patients selected for CPAP use fell into four group types. In group 1, six OSA patients underwent a tracheostomy to treat their existing OSA. These

Discussion

These data demonstrate that CPAP is an effective treatment for OSA in patients who are < 2 years old across a wide disease spectrum. This study supports and extends the findings of Guilleminault and colleagues¹⁶ concerning OSA in infants < 1 year of age to those < 2 years of age. An important finding of this study was that OSA resolved over time in nine children. It is unlikely that CPAP “cured” OSA. OSA resolution may have resulted, in part, from the nature of the children's disorders

Conclusion

The main findings of this study were the following: (1) CPAP improved OSA in all study patients; (2) CPAP can be accepted and tolerated well by a majority of patients with severe OSA who are < 2 years of age; (3) CPAP is an effective treatment modality in children with OSA; and (4) CPAP was not a permanent treatment, as nine patients no longer required CPAP based on follow-up polysomnography-documented resolution of OSA. Some of these patients had self-limiting medical problems for which CPAP

ACKNOWLEDGMENT

The authors thank Michelle Gasca for data compilation and Grennith Zimmerman, PhD, for help in the statistical analysis of the data.

References (19)

RE Dahl
The impact of inadequate sleep on children's daytime cognitive function
Semin Pediatr Neurol
(1996)
RT Brouillette et al.
Obstructive sleep apnea in infants and children
J Pediatr
(1982)
BJ Wiatrak et al.
Complications of adenotonsillectomy in children under 3 years of age
Am J Otolaryngol
(1991)
CL Marcus et al.
Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea
J Pediatr
(1995)
CL Marcus et al.
Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea
J Pediatr
(1995)
C Guilleminault et al.
Home nasal continuous positive airway pressure in infants with sleep-disordered breathing
J Pediatr
(1995)
C Rosen
Obstructive sleep apnea syndrome (OSAS) in children: diagnostic challenges
Sleep
(1996)
R Downey et al.
Upper airway resistance syndrome: sick, symptomatic but underrecognized
Sleep
(1993)
RM Perkin et al.
Sleep disordered breathing in infants and children
Respir Care Clin N Am
(1999)

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

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Citation Excerpt :
The use of continuous positive airway pressure (CPAP) is now widely reported in children for whom adenotonsillectomy is not curative for their obstructive sleep apnoea (OSA) [1–6].
A number of reports exist regarding the use of continuous positive airway pressure (CPAP) to manage obstructive sleep apnoea (OSA) in children, which we term ‘conventional CPAP’. In contrast, there are few reports of home CPAP use for other indications, which we have grouped under the term ‘cardiopulmonary’. The aims of this study were to (1) document cardiopulmonary indications for CPAP use in a cohort of infants and children, and (2) evaluate its effectiveness in this group.
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Chest

Clinical InvestigationsSLEEPNasal Continuous Positive Airway Pressure Use In Children With Obstructive Sleep Apnea Younger Than 2 Years of Age

Study objectives

Design

Setting

Patients

Intervention

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Conclusion

ACKNOWLEDGMENT

Semin Pediatr Neurol

J Pediatr

Am J Otolaryngol

J Pediatr

J Pediatr

J Pediatr

Obstructive sleep apnea syndrome (OSAS) in children: diagnostic challenges

Sleep

Upper airway resistance syndrome: sick, symptomatic but underrecognized

Sleep

Sleep disordered breathing in infants and children

Respir Care Clin N Am

Clinical Investigations
SLEEP
Nasal Continuous Positive Airway Pressure Use In Children With Obstructive Sleep Apnea Younger Than 2 Years of Age