Ventilatory management of sleep-disordered breathing in children

Liner, Lisa H.; Marcus, Carole L.

doi:10.1097/01.mop.0000193301.63259.84

Cited by 14 publications

(4 citation statements)

References 22 publications

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“…Severity of tonsil hypertrophy [ 11 ] : Oropharyngeal examination was done in all the patients on admission and the severity of tonsil hypertrophy was determined. The tonsil hypertrophy is classified into 3 types: Degree I—the enlarged tonsil exceeds the pharyngeal arch palate; Degree II—the enlarged tonsil exceeds the pharyngeal arch palate; and Degree III—the enlarged tonsil reaches the posterior pharyngeal midline.…”

Section: Methodsmentioning

confidence: 99%

Factors related to pediatric obstructive sleep apnea–hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups

Gu²,

Chen³

et al. 2017

Medicine

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This study aimed to retrospectively investigate the factors related to pediatric obstructive sleep apnea–hypopnea syndrome (OSAHS) with attention deficit hyperactivity disorder (ADHD) in children younger than 6 years and those older than 6 years.A total of 437 children who were hospitalized due to OSAHS between January 2014 and December 2014 were retrospectively reviewed. The children were further divided into OSAHS group and OSAHS + ADHD group. The general characteristics, OSA-18 quality of life, intention-hyperactivity score, and polysomnographic parameters (apnea–hypopnea index and the lowest oxygen saturation) were collected and compared between groups.There were 298 boys and 139 girls with the male to female ratio of 2.14:1. ADHD was found in 146 children including 105 boys and 41 girls with the male to female ratio of 2.56:1. Of these children, 31.62% and 35.46% had concomitant ADHD in children aged 4 to 5 years and those aged 6 to 11 years, respectively. In children aged 4 to 5 years, the incidence of allergic rhinitis was significantly higher (P = .016) and the adenoid hypertrophy was more severe (P = .001) in those with concomitant ADHD. In children aged 6 to 11 years, the tonsil hypertrophy was more severe in those with concomitant ADHD (P = .019). In children with concomitant ADHD, OSA-18 score was higher than in those with OSAHS alone (P < .001). Higher frequency of respiratory events (P < .001) and more severe hypoxia (P < .001) were found in children with concomitant ADHD than in those with OSAHS alone.As high as 30% of OSAHS children have concomitant ADHD, and the incidence of ADHD in OSAHS children is increasing over age. Boys are more likely to develop OSAHS and incidence of ADHD in OSAHS boys is higher than in OSAHS girls. In addition, risk factors of ADHD also vary between age groups. The ADHD is related to the severity of allergic rhinitis and adenoid hypertrophy in children aged 4 to 5 years, and to the severity of tonsil hypertrophy in children aged 6 to 11 years. Hypoxia may be an important factor causing ADHD. OSAHS should be treated as early as possible to reduce the incidence of ADHD in children.

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Section: Methodsmentioning

confidence: 99%

Factors related to pediatric obstructive sleep apnea–hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups

Gu²,

Chen³

et al. 2017

Medicine

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“…Furthermore, as children have lower tidal volumes and faster respiratory rates than adults; they do not always have adequate triggering and cycling of noninvasive ventilation. 13 It is therefore important that new technologies be evaluated in children before they are used clinically.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Randomized, Double-Blind Clinical Trial of Two Different Modes of Positive Airway Pressure Therapy on Adherence and Efficacy in Children

Marcus

Beck

Traylor

et al. 2012

Journal of Clinical Sleep Medicine

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Study Objectives:To determine the effects of bilevel positive airway pressure with pressure release technology (Bi-Flex) on adherence and effi cacy in children and adolescents compared to standard continuous positive airway pressure (CPAP) therapy. We hypothesized that Bi-Flex would result in improved adherence but similar effi cacy to CPAP. Methods: This was a randomized, double-blinded clinical trial. Patients with obstructive sleep apnea were randomized to CPAP or Bi-Flex. Repeat polysomnography was performed on pressure at 3 months. Objective adherence data were obtained at 1 and 3 months. Results: 56 children and adolescents were evaluated. There were no signifi cant differences in the number of nights the device was turned on, or the mean number of minutes used at pressure per night for CPAP vs Bi-Flex (24 ± 6 vs 22 ± 9 nights, and 201 ± 135 vs 185 ± 165 min, respectively, for Month 1). The apnea hypopnea index decreased signifi cantly from 22 ± 21/h to 2 ± 3/h on CPAP (p = 0.005), and 18 ± 15/h to 2 ± 2/h on Bi-Flex (p < 0.0005), but there was no signifi cant difference between groups (p = 0.82 for CPAP vs Bi-Flex). The Epworth Sleepiness Scale decreased from 8 ± 5 to 6 ± 3 on CPAP (p = 0.14), and 10 ± 6 to 5 ± 5 on Bi-Flex (p < 0.0005; p = 0.12 for CPAP vs Bi-Flex). Conclusions: Both CPAP and Bi-Flex are effi cacious in treating children and adolescents with OSAS. However, adherence is suboptimal with both methods. Further research is required to determine ways to improve adherence in the pediatric population. keywords: CPAP, obstructive sleep apnea, Bi-Flex Citation: Marcus CL; Beck SE; Traylor J; Cornaglia MA; Meltzer LJ; DiFeo N; Karamessinis LR; Samuel J; Falvo J; DiMaria M; Gallagher PR; Beris H; Menello MK. Randomized, double-blind clinical trial of two different modes of positive airway pressure therapy on adherence and effi cacy in children.

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“…We also observed high levels of leaks, probably due to oral breathing, though indices from the two groups were similar. Two reviews of CPAP compliance among children [19,20] have discussed the best practices for improving compliance. The information that was given to parents on the importance of preoperatory safety measures appears not to have been sufficient to convince them to monitor good CPAP compliance.…”

Section: Discussionmentioning

confidence: 99%

Preoperative continuous positive airway pressure compliance in children with obstructive sleep apnea syndrome: Assessed by a simplified approach

Castorena-Maldonado

Torre-Bouscoulet

Meza-Vargas

et al. 2008

International Journal of Pediatric Otorhinolaryngology

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Ventilatory management of sleep-disordered breathing in children

Abstract: Continuous positive airway pressure is a useful second-line treatment for children with sleep-disordered breathing. Strategies to improve adherence are needed. Equipment manufacturers should be encouraged to develop equipment that better meets children's needs.

Cited by 14 publications

References 22 publications

Factors related to pediatric obstructive sleep apnea–hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups

Factors related to pediatric obstructive sleep apnea–hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups

Randomized, Double-Blind Clinical Trial of Two Different Modes of Positive Airway Pressure Therapy on Adherence and Efficacy in Children

Preoperative continuous positive airway pressure compliance in children with obstructive sleep apnea syndrome: Assessed by a simplified approach

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