University of Queensland and Ochsner Health System, Brisbane, Australia.
Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
J Clin Sleep Med. 2022 Apr 1;18(4):1145-1151. doi: 10.5664/jcsm.9836.
Sleep-disordered breathing is a major cause of morbidity and mortality among pediatric patients with severe neurological disabilities such as cerebral palsy. Despite increasing use of noninvasive ventilation (NIV) in this group, there remains a lack of consensus about its role and indications. We aim to explore the indications, acceptability, and outcomes of a cohort of children with severe, complex neurological disability and sleep-disordered breathing, managed with NIV.
Data were retrospectively extracted on children with severe neurological disabilities (Gross Motor Function Classification System V equivalent) initiated on NIV in Queensland over a 5-year period. Demographic, clinical, hospitalization, and polysomnography data were collected, as well as caregiver-reported side effects and NIV adherence.
Fourteen (median age 9.1 years; 6 female) children were included, 8 with cerebral palsy and 6 with other complex neurological disabilities. Obstructive sleep apnea was the most common indication for NIV (n = 12). The median (interquartile range) apnea-hypopnea index improved on NIV [pre-NIV 21.3 (interquartile range 10.0-28.2) vs post-NIV 12.2 (interquartile range 2.8-15.2)], although this was not statistically significant. There was significant improvement in proportion of time spent with SpO < 95% (22.2% pre-NIV vs 7.85% post-NIV; < .05). Reported side effects were minimal. There was no reduction in hospital admissions in the 12 months post-NIV initiation.
Our findings suggest that NIV improves polysomnography parameters among children with severe neurological disability. Long-term outcomes and overall impact on quality of life remain unclear. Ethical issues and overall benefit must be considered before embarking on this mode of therapy.
Morrison L, Suresh S, Leclerc MJ, Kapur N. Symptom care approach to noninvasive ventilatory support in children with complex neural disability. . 2022;18(4):1145-1151.
睡眠呼吸障碍是脑瘫等严重神经功能障碍儿科患者发病率和死亡率的主要原因。尽管在该人群中越来越多地使用无创通气（NIV），但其作用和适应证仍缺乏共识。我们旨在探讨一组严重、复杂神经功能障碍和睡眠呼吸障碍儿童使用 NIV 的适应证、可接受性和结局。
对昆士兰州在 5 年内开始使用 NIV 的严重神经功能障碍（粗大运动功能分类系统 V 级等效）儿童进行回顾性数据提取。收集人口统计学、临床、住院和多导睡眠图数据，以及护理人员报告的副作用和 NIV 依从性。
纳入了 14 名（中位年龄 9.1 岁；6 名女性）儿童，其中 8 名患有脑瘫，6 名患有其他复杂神经障碍。阻塞性睡眠呼吸暂停是 NIV 的最常见适应证（n = 12）。NIV 后呼吸暂停低通气指数中位数（四分位距）改善[NIV 前 21.3（四分位距 10.0-28.2）与 NIV 后 12.2（四分位距 2.8-15.2）]，尽管这无统计学意义。SpO < 95%的时间比例有显著改善（NIV 前 22.2%与 NIV 后 7.85%；<.05）。报告的副作用很少。NIV 启动后 12 个月内住院人数没有减少。
我们的研究结果表明，NIV 可改善严重神经功能障碍儿童的多导睡眠图参数。长期结果和对生活质量的总体影响仍不清楚。在开始这种治疗模式之前，必须考虑伦理问题和总体获益。
Morrison L, Suresh S, Leclerc MJ, Kapur N. 复杂神经残疾儿童非侵入性通气支持的症状护理方法。 2022;18(4):1145-1151.
