Chest
Volume 116, Issue 1, July 1999, Pages 10-16
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Clinical Investigations
Sleep
Obstructive Sleep Apnea in Infants and Its Management With Nasal Continuous Positive Airway Pressure

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Study objectives

Nasal continuous positive airway pressure (nCPAP) is the most common treatment for obstructive sleep apnea (OSA) in adults, and it has been effective in the treatment of OSA in children. We wanted to determine the effectiveness of long-term nCPAP therapy for OSA in infants.

Patients

Twenty-four infants who had OSA were treated with nCPAP via nose mask. These infants had clinical histories that included a family history of sudden infant death syndrome, an apparent life-threatening event, or facial and upper airway anatomic abnormalities.

Interventions

Overnight polysomnographic studies were performed to assess the severity of OSA in each infant and to determine the appropriate level of continuous positive airway pressure (CPAP). Studies were repeated to determine the progress of OSA and the continuing need for CPAP in each infant.

Results

nCPAP pressures between 4 and 6 cm H2O prevented obstruction and reversed sleep disturbances that were associated with OSA. Eighteen of the infants continued treatment at home from 1 month to > 4 years. CPAP therapy was discontinued in 13 infants after their OSA resolved. Five infants who have upper airway anatomic abnormalities remain on CPAP, and the pressure level required to prevent obstructive events during sleep has needed to be increased to as high as 10 cm H2O.

Conclusions

nCPAP is an effective therapy for the management of OSA in infants, and it can be used effectively in the home environment. Regular follow-up is necessary, because the requirements for CPAP and pressure levels change with the infant's growth and development.

Section snippets

Materials and Methods

Studies were performed on 24 infants (15 boys and 9 girls from 1 to 51 weeks old), who had been referred to the sleep disorders clinic for investigation of OSA (Table 1). The infants were selected for CPAP treatment because they had mixed and obstructive apneas of > 5 apneas/h of sleep that were recorded during an overnight polysomnographic study (in 21 infants) or an overnight ambulatory study (in 3 infants). The mean (± SEM) gestation age was 37.6 ± 0.7 weeks old (range, 30 to 42 weeks old);

Effects of nCPAP on Sleep Apnea and Sleep

All infants had obstructive and central events recorded on their diagnostic study that were associated with decreases in Sao2 (Fig 1). Sixteen of the 24 infants had a CPAP PD study the night after their diagnostic study. The remaining infants were treated with low-level nCPAP (3.7 cm H2O) during sleep as inpatients of the hospital, until their CPAP PD study could be performed. In total, 21 of the infants underwent a CPAP PD study within 2 weeks of their diagnostic study. Of these 21 infants, 18

Discussion

We successfully used nCPAP via mask to treat OSA in > 85% of infants, and it was possible to use CPAP as a long-term treatment in the infants’ homes. The previous use of nCPAP to treat OSA in infants has been limited. CPAP delivered via nasal prongs or an endotracheal tube has been used extensively to treat respiratory distress and apnea of prematurity in preterm infants.15 This application of CPAP was applied to support and inflate the lungs, rather than to support the upper airway. There have

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  • Cited by (0)

    Supported by the National Health and Medical Research Council (NHMRC)of Australia.

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