Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Chest. 2021 Feb;159(2):810-817. doi: 10.1016/j.chest.2020.08.020. Epub 2020 Aug 15.
Positive airway pressure (PAP) is a standard therapy for the treatment of OSA in children, but objective data on the effectiveness of PAP in infants are sparse. The aim of this study was to compare the effectiveness of PAP in infants younger than 6 months of age with that in school-aged children.
Compared with PAP in school-aged children, can PAP be titrated as successfully in infants, and is adherence to PAP similar in both age groups?
Single-center retrospective study. For consecutive infants younger than 6 months of age and school-aged children 5 to 10 years of age with OSA treated with PAP, baseline and titration polysomnography data, PAP adherence data, and parent-reported barriers to adherence were compared between groups.
Forty-one infants and 109 school-aged children were included. Median obstructive apnea hypopnea index (OAHI) in infants was 25.7/h (interquartile range [IQR], 17.8-35.9/h) and was greater than that in school-aged children (12.1/hr; IQR, 7.6-21.5/h; P < .0001). After PAP titration, OAHI was reduced by a median of 92.1% in infants, similar to the median 93.4% reduction in school-aged children (P = .67). PAP was used in infants on 94.7% of nights, which was more than the 83% in school-aged children (P = .003). No differences were found in barriers to adherence between infants and school-aged children, with behavioral barriers being most common in both groups.
Objective data demonstrate that PAP is both highly effective at treating OSA and well-tolerated in infants. Like older patients, PAP should be considered along with other therapies for the treatment of OSA in even the youngest children.
正压通气（PAP）是治疗儿童阻塞性睡眠呼吸暂停（OSA）的标准疗法，但婴儿使用 PAP 的有效性的客观数据很少。本研究旨在比较 6 个月以下婴儿和学龄儿童使用 PAP 的效果。
与学龄儿童的 PAP 相比，能否成功滴定婴儿的 PAP，并且两组的 PAP 依从性是否相似？
单中心回顾性研究。对连续的患有 OSA 并接受 PAP 治疗的 6 个月以下婴儿和 5 至 10 岁的学龄儿童进行了基线和滴定多导睡眠图数据、PAP 依从性数据以及父母报告的依从性障碍的比较。
共纳入 41 例婴儿和 109 例学龄儿童。婴儿的中位阻塞性呼吸暂停低通气指数（OAHI）为 25.7/h（四分位距 [IQR]，17.8-35.9/h），高于学龄儿童（12.1/h；IQR，7.6-21.5/h；P<0.0001）。经过 PAP 滴定后，婴儿的 OAHI 降低了中位数 92.1%，与学龄儿童的中位数 93.4%降低相似（P=0.67）。婴儿中有 94.7%的夜间使用 PAP，高于学龄儿童的 83%（P=0.003）。婴儿和学龄儿童的依从性障碍没有差异，两组中行为障碍最常见。
客观数据表明，PAP 不仅治疗 OSA 非常有效，而且在婴儿中也能很好耐受。与年长的患者一样，即使是最小的儿童，也应考虑将 PAP 与其他疗法一起用于 OSA 的治疗。
