Midfacial and Dental Changes Associated with Nasal Positive Airway Pressure in Children with Obstructive Sleep Apnea and Craniofacial Conditions

Roberts, Soleil de Marsche; Kapadia, Hitesh; Greenlee, Geoff; Chen, Maida L.

doi:10.5664/jcsm.5668

Cited by 80 publications

(71 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[6][7][8][9] Desensitization is effective but timeconsuming, 10,11 complaints of side effects are common, 7 and the adverse effects of CPAP on a developing face are increasingly recognized. 12 Many attempts to improve tolerability and adherence of CPAP therapy have proven ineffective. Trials of bilevel positive airway pressure, autotitrating positive airway pressure, and comfort features, such as pressure relief during exhalation, all demonstrate efficacy but adherence remains poor.…”

mentioning

confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Methods: Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Results: Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). Conclusions: High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.

show abstract

mentioning

confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…In a retrospective cohort study, mid‐facial growth was compared in paediatric patients with underlying craniofacial conditions diagnosed with OSA who were compliant versus non‐compliant with n‐CPAP therapy. They found pressure to the mid‐face from compliant n‐CPAP use altered annual rate of facial growth . A cross‐sectional study by Fauroux et al .…”

Section: Pressure‐related Side Effectsmentioning

confidence: 99%

“…Mid‐facial hypoplasia or reduced face growth due to CPAP use has been reported in multiple cases . Li et al .…”

Section: Pressure‐related Side Effectsmentioning

confidence: 99%

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

Ghadiri

Grunstein

2020

Respirology

View full text Add to dashboard Cite

CPAP is considered the gold standard treatment in OSA and is highly efficacious in controlling OSA symptoms. However, treatment effectiveness is limited because of many factors including low adherence due to side effects. This review highlights the range of side effects associated with CPAP therapy in patients with OSA. This information is important for the initiation of patients onto CPAP as well as their continued care while on treatment, given the increase in non-medically supervised CPAP care models in use globally.

show abstract

“…Close maxillo-facial follow up is recommended for all patients with mask ventilation. Mask ventilation has been related to mid-face deformation, especially when introduced in the first years of life or with prolonged or tight application of the mask [75]. The severity of this complication may be reduced with newer total face masks, or by alternating between different shapes of masks and avoiding tight fitting.…”

Section: Mask Ventilationmentioning

confidence: 99%

Guidelines for diagnosis and management of congenital central hypoventilation syndrome

Trang

Samuels

Ceccherini

et al. 2020

Orphanet J Rare Dis

100

137

View full text Add to dashboard Cite

Background Congenital Central Hypoventilation Syndrome (CCHS) is a rare condition characterized by an alveolar hypoventilation due to a deficient autonomic central control of ventilation and a global autonomic dysfunction. Paired-like homeobox 2B (PHOX2B) mutations are found in most of the patients with CCHS. In recent years, the condition has evolved from a life-threatening neonatal onset disorder to include broader and milder clinical presentations, affecting children, adults and families. Genes other than PHOX2B have been found responsible for CCHS in rare cases and there are as yet other unknown genes that may account for the disease. At present, management relies on lifelong ventilatory support and close follow up of dysautonomic progression. Body This paper provides a state-of-the-art comprehensive description of CCHS and of the components of diagnostic evaluation and multi-disciplinary management, as well as considerations for future research. Conclusion Awareness and knowledge of the diagnosis and management of this rare disease should be brought to a large health community including adult physicians and health carers.

show abstract

Midfacial and Dental Changes Associated with Nasal Positive Airway Pressure in Children with Obstructive Sleep Apnea and Craniofacial Conditions

Abstract: Pressure to the midface from compliant nPAP use may alter normal facial growth. Cephalometric findings indicate a greater need for collaboration between sleep medicine physicians and orthodontists to monitor midfacial growth during nPAP treatment.

Cited by 80 publications

References 26 publications

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

Guidelines for diagnosis and management of congenital central hypoventilation syndrome

Contact Info

Product

Resources

About