The treatment of sleep apnea in young children using bilevel positive airway pressure

Czech version

Authors: I. Příhodová ¹; K. Šonka ¹; M. Pretl ¹; P. Klement ²; M. Jakoubková ¹; D. Kemlink ¹; P. Jiroutek ¹; S. Nevšímalová ¹
Authors‘ workplace: Neurologická klinika VFN a 1. LF UK, Praha ¹; Klinika dětského a dorostového lékařství VFN a 1. LF UK, Praha ²
Published in: Cesk Slov Neurol N 2007; 70/103(4): 429-434
Category: Case Report

Overview

Sleep apnea is prevailingly caused by an obstruction in the upper respiratory tract (URT); less often it is linked with a central respiratory control disorder. The factors contributing to the development of sleep apnea are adenoid vegetation and tonsillar hypertrophy combined with slight deviations in the structure and functioning of the URT. All diseases causing anatomic or functional changes in the URT (craniofacial malformations, achondroplasias, gastroesophageal reflux, Down syndrome, poliomyelitis, nerve-muscle diseases) also involve the risk of sleep apnea. The treatment of first choice for sleep apnea in child age is adenotonsilectomy. Treatment with constant positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) in children is reserved for states in which adenotonsilectomy is not indicated for or ineffective in the treatment of obstructive sleep apnea (OSA), and for central apnea. We include case studies of 3 child patients aged between 1,5 to 5 years successfully treated by BiPAP. We point out the necessity for early diagnosing and treatment of sleep apnea in risk patients and the good compliance with BiPAP treatment in infant and pre-school age.

Key words:
obstructive sleep apnoea – central sleep apnea – child age – constant positive airway pressure – bilevel positive airway pressure

Sources

1. O’Brien, LM, Gozal D. Consequences of obstructive sleep apnea syndrome. In: Sheldon SH, Ferber R, Kryger MH. Principles and practice of pediatric sleep medicine. Philadelphia: Elsevier Saunders 2005: 211-222.

2. Brooks LJ. Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Sheldon SH (ed). Principles and practice of pediatric sleep medicine. Philadelphia: Elsevier Saunders 2005: 223-229.

3. Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med 1998; 157: 1098-1103.

4. Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionucleide assessment. Pediatr Pulmonol 1988; 4: 139-143.

5. Kotagal S. Sleep in children with neurological disorders. In: Lee-Chiong. Sleep – a comprehensive handbook. New Jersey: Wiley-Liss 2006: 567-573.

6. Wills LM, Shift JQ, Miller KT. Craniofacial syndromes and sleep disorders. In: Lee-Chiong. Sleep – a comprehensive handbook. New Jersey: Wiley-Liss; 2006: 551-560.

7. American Academy of Pediatrics, Section on Pediatric Pulmonology, Subcommitttee on obstructive sleep apnea: clinical practice guideline: Diagnosis nad management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109: 704-712.

8. Carr MM, Brodsky L. Severe non- obstructive sleep disturbance as an initial presentation of gastroesophageal reflux disease. Int J Ped Otorhinolar 1999; 51: 115-120.

9. Kerr P, Shoenut JP, Millar T, Buckle P, Kryger MH. Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest 1992; 101: 1539-1544.

10. Wasilewska J, Kaczmarski M. Sleep- related breathing disorders in small children with nocturnal acid gastroesophageal reflux. Rocz Akad Med Bialymst 2004; 49: 98-102

11. Wyler AR, Weymuller EA. Epilepsy complicated by sleep apnea. Ann Neurol 1981; 9: 403-404.

12. Devinski O, Ehrenberg B, Barthlen GM, Abramson HS, Luciano D. Epilepsy and sleep apnea syndrome. Neurology 1994; 44: 2060-2064.

13. Mallow BA,Weatherwax KJ, Chervin RD. Identification and treatment of obstructive sleep apnea in adults and children with epilepsy:a prospective pilot study. Sleep Med 2003; 4: 509-515.

14. Vaughn BV, D’Cruz OF, Brach R, Messenheimer JA. Improvement of epileptic seizure control with treatment of obstructive sleep apnea. Seizure 1996; 5: 73-8.

15. Koh S, Ward SL, Lin M, Chen LS. Sleep apnea treatment improves seizure control in children with neurodevelopmental disorders. Ped Neurol 2000; 22: 36-39

16. Marcus CL. Treatment of obstructive sleep apnea syndrome in children. In: Sheldon SH, Ferber R, Kryger MH (ed). Principles and practice of pediatric sleep medicine. Philadelphia: Elsevier Saunders; 2005: 235-247.

17. Waters KA, Everest F, Bruderer JW, Sullivan CE. Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 1995; 152: 780-785.

18. Friedman O, Chidekel A, Lawless ST, Cook SP. Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children- a preliminary report. Int J Pediatr Otorhinolaryngol 1999; 5: 177-180.

19. Guilleminault C, Pelayo R, Clerck A. Home nasal continuous positive airway pressure in infants with sleep- disordered breathing. J Pediatr 1995; 127: 905-912.

20. McNamara F, Sullivan CE. Obstructive sleep apnea in infants and its mangemenet with nasal continuous positive airway pressure. Chest 1999; 116: 10-16.

21. McNamara F, Sullivan CE. Treatment of obstructive sleep apnea syndrome in children. Sleep 2000; 23(Suppl 4): S142-S146.

22. Witmans MB, Chen ML, Davidson Ward SL, Keens TG. Congenital syndromes affecting respiratory control during sleep. In: Lee-Chiong. Sleep – a comprehensive handbook. New Jersey: Wiley-Liss 2006: 517-527.