The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy

Hsiao, Kai Hsun; Nixon, Gillian M.

doi:10.1016/j.ridd.2007.01.003

Cited by 61 publications

(49 citation statements)

References 23 publications

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“…b) Children with Duchenne muscular dystrophy and nocturnal hypoxaemia not receiving treatment for SDB are at risk of pulmonary hypertension (class IV) [89]. Patients with cerebral palsy and OSAS have improvements in symptoms and quality of life when CPAP, adenotonsillectomy or other surgical interventions are implemented to relieve upper airway obstruction compared with untreated children (class IV) [187][188][189]. c) Class III or IV studies have demonstrated high prevalence of OSAS, central apnoeas or central hypoventilation, and pulmonary hypertension in children with achondroplasia and improvement after adenotonsillectomy, weight loss, CPAP, NPPV or surgical dorsal decompression of the craniovertebral junction [42-44, 190, 191].…”

Section: Literature Reviewmentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: Literature Reviewmentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…improved sleep quality, daytime functioning, behaviour and cognition and QoL). One retrospective study30 found improvement of QoL in 10 patients with non-ambulant CP treated with either adenotonsillectomy or CPAP (n=3) in comparison with the untreated group. Improvement of caregiver concerns, sleep disturbance and daytime functioning was seen in the treatment group.…”

Section: Role Of Non-invasive Ventilation (Niv) In Cpmentioning

confidence: 99%

Use of non-invasive ventilation in cerebral palsy

Grychtol

Chan

2018

Arch Dis Child

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Patients with cerebral palsy (CP), especially those at the severe end of the spectrum (Gross Motor Function Classification System levels IV-V equivalent), frequently suffer from sleep disturbance and sleep-disordered breathing (SDB). Non-invasive ventilation (NIV) is increasingly used in this patient group, albeit with little published evidence of its effectiveness in CP. This article aims to review the current evidence in the use of NIV in children with CP, highlighting areas of uncertainties, as well as the balance of potential risks, challenges and benefits. We would also share our experience and practical considerations in using NIV to manage SDB in this group of patients. Between January 2010 and December 2016, 21 patients (median age 11.1 (range 1.7-16.1) years) with CP were initiated on NIV at Great Ormond Street Hospital for Children following diagnosis of moderate to severe SDB on cardiorespiratory polygraphy. Over half of our patients with CP (n=11) failed to establish on NIV either due to intolerance of mask and/or ventilation pressure at the initial trial in hospital, or poor adherence during follow-up, in contrast to the overall failure rate of 8.7% among total patient population commenced on NIV. Children with CP constitute a relatively small but challenging group of patients. Decision to undertake NIV should be individualised, based on benefit outweighing the risk and burden of the treatment.

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“…Hawkins, MD 1,2 ; Emily L. Jensen, BS 3,4 may result in development of the aforementioned comorbidities, compromised daily functioning, increased health care utilization, and contribution to early mortality. 6,[15][16][17][18][19][20][21][22][23] OSA severity, pressure settings, and mask type, have not been found to affect use, 14,[24][25][26][27][28][29][30] whereas psychosocial factors and perception of OSA's importance do. 14,23,31 One study suggested that higher maternal education correlated with higher adherence.…”

Section: Correlates Of Pediatric Cpap Adherencementioning

confidence: 99%

Correlates of Pediatric CPAP Adherence

Hawkins

Jensen

Simon

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ 2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

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The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy

Cited by 61 publications

References 23 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Use of non-invasive ventilation in cerebral palsy

Correlates of Pediatric CPAP Adherence

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