NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN. Dr. Nguyễn Quỳnh Anh Department of Respiration 1
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1 1 NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN Dr. Nguyễn Quỳnh Anh Department of Respiration 1
2 CONTENTS 2 1. Preface 2. Definition 3. Etiology 4. Symptoms 5. Complications 6. Diagnostic 7. Treatment 8. NCPAP 9. Summary
3 PREFACE 3 Recent data from the USA and Europe: 14-49% of middle-aged men have clinically significant OSA 2-3% of all children from the newborn age to adolescence Equally in boys and girls A peak incidence in 2 and 8 years
4 DEFINITION 4 Obstructive sleep apnea (OSA) is defined as 5 episodes of apnea (nonbreathing) lasting 10 per hour of sleep Characterised by intermittent partial and/or complete upper airway obstruction during sleep that may impair normal ventilation and sleep pattern
5 5 ETIOLOGY
6 6 SYMPTOMS
7 7 COMPLICATIONS
8 DIAGNOSTIC 8 Polysomnography remains the gold standard of pediatric OSA
9 DIAGNOSTIC 9 Apnea-hypopnea index (AHI) is the total number of apneas and hypopneas that occur divided by the total duration of sleep in hours < 1: normal 1-5: very mildly increased 5 10: mildly increased 10 20: moderately increased > 20: severely abnormal
10 TREATMENT 10 Indications: AHI > 5, irrespective to the presence of morbidity AHI 1 5, with OSA-related morbidity Increasing body mass index percentile and male gender are risk factor for persistent OSA Subjects with neuromuscular disorders and craniofacial anomalies
11 TREATMENT 11 Administration of anti-inflammatory medications Adenotonsillectomy Weight loss Use of orthodontic appliance Nasal continuous airway pressure (NCPAP) Tracheostomy
12 NCPAP 12 NCPAP is delivered by a flow generator to the patient via nasal mask or modified nasal prongs The device provides a pneumatic splint of the upper airway, preventing excessively high negative inspiratory pressures which cause closure of this airway segment
13 NCPAP 13 Indications: Children who are not eligible for adenoidectomy and tonsillectomy (T & A) Children whose sleep-breathing disorder persisted despite T & A
14 NCPAP 14 CHEST 1999
15 15 NCPAP
16 NCPAP 16 CHEST 2000
17 17 NCPAP
18 NCPAP 18 American Journal of Respiratory and Critical Care Medicine, 2012
19 19 NCPAP
20 NCPAP 20 The Journal of Pediatrics, Volume 127, Number 1, 1995
21 NCPAP 21 Archives of Disease in Childhood, 2002
22 22 NCPAP
23 23 NCPAP
24 NCPAP 24 SLEEP 2006
25 25 NCPAP
26 NCPAP 26 Sleep Medicine Clinics, 2014
27 27 NCPAP
28 NCPAP 28 Case 1
29 NCPAP 29 Case 2
30 SUMMARY 30 NCPAP therapy has been shown to be effective in the management of OSA in infants Complications are minor The vast majority of children are able to be established on NCPAP, with most children wearing NCPAP for a substantial part of the night
31 REFERENCES Epidemiological aspects of obstructive sleep apnea, John F. Garvey et al, Journal of Thoracic Disease, Pediatric obstructive sleep apnea, Bantu S. Chhangani et al, Indian Journal of Pediatrics, Sleep apnea in children, Brooke Elizabeth Holman, Obstructive sleep apnoea in children, S. Verhulst and A. Kaditis, Breath, Vol. 7, 2011
32 REFERENCES Childhood sleep apnea, Mary E. Cataletto et al, Nasal breathing and Continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA), Jan H. Hollandt et al, Sleep and Breathing, Vol. 7, Obstructive sleep apnea in infants and its management with nasal continuous positive airway pressure, Frances McNamara et al, Chest 1999
33 REFERENCES Nasal continuous positive airway pressure use in children with obstructive sleep apnea younger than 2 years of age, Ralph Downey III et al, Chest, Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea, Carole l. Marcus et al, The Journal of Pediatrics, Compliance rates in children using noninvasive continuous positive airway pressure, Anne R. O Donnell et al, Sleep, 2006
34 REFERENCES The use of nasal continuous positive airway pressure to treat obstructive apnoea, F. Massa et al, Arch Dis Child, Treatment of obstructive sleep apnea in children, Young Min Ahn, The Korean Journal of Pediatrics, Effects of positive airway pressure therapy on neurobehavioral outcomes in children with obstructive sleep apnea, Carole L. Marcus, American Journal of Respiratory and Critical Care Medicine, Improving positive airway pressure adherence in children, Michelle S. King, Sleep Med Clin, 2014
35 THANKS FOR YOUR ATTENTION! 35 Good night!!!
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