Massa F, Gonsalez S, Laverty A, Wallis C, Lane R
Respiratory Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Arch Dis Child. 2002 Nov;87(5):438-43. doi: 10.1136/adc.87.5.438.
To review 66 children with obstructive sleep apnoea (OSA) for whom a trial of nasal continuous positive airway pressure (nCPAP) was proposed.
Baseline sleep studies were performed to assess OSA severity; a trial of nCPAP was performed where moderate to severe OSA, not relieved by adenotonsillectomy, was found. The nCPAP trial was considered either technically successful (ST), if the child accepted the mask for sufficient time to determine nCPAP efficacy, or a technical failure (FT) if otherwise. Patients with an initial FT were offered a period of home acclimatisation to familiarise them with wearing the mask during sleep. ST patients in whom nCPAP was effective were established on long term therapy.
Nasal CPAP trials were successful (ST) in 49/66 (74%) patients. Nasal CPAP efficacy could not be determined in the remaining 17 FT patients (26%), generally because of their poor nCPAP tolerance. These patients were subsequently considered for other treatment. A total of 42/49 (86%) ST patients were established on long term nCPAP therapy, 2/49 (4%) derived no benefit from nCPAP, while 5/49 (10%) refused long term nCPAP therapy. Of patients on long term nCPAP, the most frequently reported side effects were skin irritation and nasal dryness; however, these were not serious enough to require any patients to discontinue therapy. A period of home acclimatisation was found to be effective in increasing nCPAP acceptance, with 26% of FT children being subsequently successfully reassessed for nCPAP.
The use of nCPAP was feasible in a significant proportion of a paediatric OSA population. Failure was usually because of the child's intolerance of the nCPAP equipment. Nasal CPAP was an effective treatment in the majority of patients where it could be assessed, and was adopted as a long term therapy in most cases. We have successfully used nCPAP to treat OSA across a wide range of ages. Motivated parents and skilled support staff have proved essential for the success of nCPAP in a paediatric setting.
对66例拟行鼻腔持续气道正压通气（nCPAP）试验的阻塞性睡眠呼吸暂停（OSA）儿童进行回顾性研究。
进行基线睡眠研究以评估OSA严重程度；对于发现经腺样体扁桃体切除术不能缓解的中重度OSA患儿进行nCPAP试验。若患儿接受面罩的时间足够长以确定nCPAP疗效，则nCPAP试验被认为技术成功（ST）；否则为技术失败（FT）。初始为FT的患者会有一段时间在家适应，以使他们熟悉睡眠时佩戴面罩。nCPAP有效的ST患者接受长期治疗。
66例患者中49例（74%）的鼻腔CPAP试验成功（ST）。其余17例FT患者（26%）无法确定鼻腔CPAP疗效，通常是因为他们对nCPAP耐受性差。这些患者随后考虑其他治疗。49例ST患者中共有42例（86%）接受长期nCPAP治疗，2例（4%）未从nCPAP中获益，而5例（10%）拒绝长期nCPAP治疗。长期接受nCPAP治疗的患者中，最常报告的副作用是皮肤刺激和鼻干；然而，这些副作用并不严重，无需任何患者停止治疗。发现一段时间的在家适应对于提高nCPAP接受度有效，26%的FT儿童随后重新评估nCPAP成功。
在相当一部分小儿OSA患者中使用nCPAP是可行的。失败通常是因为儿童对nCPAP设备不耐受。在大多数可评估的患者中，鼻腔CPAP是一种有效的治疗方法，并且在大多数情况下被用作长期治疗。我们已成功使用nCPAP治疗广泛年龄段的OSA。事实证明，积极的家长和技术熟练的支持人员对于小儿环境中nCPAP的成功至关重要。
