Management of sleep‐disordered breathing in children with complex disorders: One size does not fit all

Kaditis, Athanasios G.

doi:10.1002/ppul.24143

Cited by 3 publications

(7 citation statements)

References 26 publications

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“…[52][53][54] Up to 60% of children with DS have a history of congenital and structural heart disease, this in turn, increases their predisposition to the development, persistence and recurrence of pulmonary hypertension if OSA goes untreated or, in fact undertreated. 14,15,26 Congenital heart disease has previously been suggested to undermine the efficacy of upper airway surgical outcome. 22 In this study, 77% of this DS cohort has a past medical history that includes cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

“…Children with DS are more susceptible to developing the adverse sequelae of OSA largely due to the myriad of comorbidities, 27 and as such The American Academy of Pediatrics (AAP) recommend screening for OSA before the age of 4 in all children with DS, a sentiment echoed by the Royal College of Paediatrics and Child Health 52–54 . Up to 60% of children with DS have a history of congenital and structural heart disease, this in turn, increases their predisposition to the development, persistence and recurrence of pulmonary hypertension if OSA goes untreated or, in fact undertreated 14,15,26 . Congenital heart disease has previously been suggested to undermine the efficacy of upper airway surgical outcome 22 …”

Section: Discussionmentioning

confidence: 99%

“…Within DS there is a propensity for congenital cardiac defects to affect the respiratory system, and vice versa, in which respiratory disease, including OSA, affects the heart and the pulmonary vasculature 14 . OSA‐induced recurrent hypoxemia has been shown to alter pulmonary vessel resistance leading to the development, persistence and recurrence of pulmonary hypertension, right‐sided heart failure, and cor pulmonale 14–16 . Sleep‐disordered breathing has also been linked to enhanced sympathetic drive as well as worse left ventricular diastolic function 17 …”

Section: Introductionmentioning

confidence: 99%

“…14 OSA-induced recurrent hypoxemia has been shown to alter pulmonary vessel resistance leading to the development, persistence and recurrence of pulmonary hypertension, right-sided heart failure, and cor pulmonale. [14][15][16] Sleep-disordered breathing has also been linked to enhanced sympathetic drive as well as worse left ventricular diastolic function. 17 The management of OSA within the DS population involves a multidisciplinary approach.…”

mentioning

confidence: 99%

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Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome

MacDonagh

Farrell

O'Reilly

et al. 2021

Pediatric Pulmonology

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Objective: Children with Down syndrome (DS) have an increased prevalence of obstructive sleep apnea (OSA). Noninvasive ventilation (NIV) is a common modality of OSA treatment in this cohort. This study aimed to measure adherence and efficiency of NIV delivery in children with DS.Study design: This was a retrospective cohort study involving 106 children with confirmed OSA and home NIV with downloadable data capacity. Children were divided into DS (n = 44) and non-DS cohorts (n = 62). Adherence, clinical outcomes apnea-hypopnoea index (AHI), positive airway pressure delivery, and leakage were recorded and compared between DS and non-DS cohorts and within the DS cohort based on past surgical history.Results: Significantly greater NIV usage was observed in the DS cohort, they showed more consistent use with an increased percentage of days used relative to their non-DS counterparts (78.95 ± 2.26 vs. 72.11 ± 2.14, p = .031). However, despite greater usage, poorer clinical outcomes in the form of increased AHI (p = .0493) was observed in the DS cohort, where significantly greater leakage was also shown 41.00 ± 1.61 L/min versus 36.52 ± 1.18 L/min (p = .022). Twenty children with DS had prior cardiac surgery; compliance across all parameters was significantly reduced relative to those without. Conclusion:These data confirm that satisfactory NIV adherence is achievable in children with DS. However, we have identified excessive system leak at the machine-patient interface as a factor, which could undermine NIV efficacy in children with DS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome

MacDonagh

Farrell

O'Reilly

et al. 2021

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…Within DS there is a propensity for congenital cardiac defects to affect the respiratory system, and vice versa, in which respiratory disease, including OSA, affects the heart and the pulmonary vasculature 14 . OSA-induced recurrent hypoxaemia has been shown to alter pulmonary vessel resistance leading the development, persistence and recurrence of pulmonary hypertension, right-sided heart failure and cor pulmonale [14][15][16] . Sleep disordered breathing has also been linked to enhanced sympathetic drive as well as worse left ventricular diastolic function 17 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and adherence of non-invasive ventilation treatment in children with Down syndrome

MacDonagh¹,

Farrell²,

O'Reilly³

et al. 2020

Preprint

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Objective: Children with Down syndrome (DS) have an increased prevalence of obstructive sleep apnoea (OSA). Non-invasive ventilation (NIV) is a common modality of OSA treatment in this cohort. This study aimed to measure adherence and efficiency of NIV delivery in children with DS. Study design: This was a retrospective cohort study involving 106 children with confirmed OSA and home NIV with downloadable data capacity. Children were divided into DS (n=44) and non-DS cohorts (n=62). Adherence, clinical outcomes apnoea-hypopnoea index (AHI), positive airway pressure delivery and leakage were recorded and compared between DS and non-DS cohorts and within the DS cohort based on past surgical history. Results: Significantly greater NIV usage was observed in the DS cohort, they showed more consistent use with an increased percentage of days used relative to their non-DS counterparts (78.95 ± 2.26 versus 72.11 ± 2.14, p=0.031). However, despite greater usage, poorer clinical outcomes in the form of increased AHI (p=0.0493) was observed in the DS cohort, where significantly greater leakage was also shown 41.00 ± 1.61L/min versus 36.52 ± 1.18L/min (p=0.022). Twenty children with DS had prior cardiac surgery; compliance across all parameters was significantly reduced relative to those without. Conclusions: These data confirm that satisfactory NIV adherence is achievable in children with DS. However, we have identified excessive system leak at the machine-patient interface as a factor, which could undermine NIV efficacy in children with DS.

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Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue

et al. 2022

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Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.

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Management of sleep‐disordered breathing in children with complex disorders: One size does not fit all

Cited by 3 publications

References 26 publications

Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome

Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome

Efficacy and adherence of non-invasive ventilation treatment in children with Down syndrome

Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue

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