Department of Respiratory and Sleep Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
School of medicine, University of Queensland, South Brisbane, Australia.
J Clin Sleep Med. 2023 Mar 1;19(3):473-477. doi: 10.5664/jcsm.10366.
There are limited data on indications and outcomes of home continuous positive airway pressure (CPAP) therapy in the first year of life. We aimed to analyze the clinical, demographic, and polysomnographic characteristics of a cohort of children initiated on home CPAP for treatment of sleep-disordered breathing and as respiratory support in the first year of life.
Children started on CPAP in the first year of life at the Queensland Children's Hospital were retrospectively evaluated for clinical and demographic parameters, underlying diagnoses, respiratory support, airway surgical intervention, and polysomnography results at baseline and on CPAP.
Twenty-nine infants (median age [interquartile range] at CPAP initiation, 182 days [126-265.5 days]) were included. The underlying etiology included Trisomy 21 (n = 6), craniofacial syndromes (n = 5), hypotonia (n = 8; 5 with noncraniofacial syndrome), airway malacia (n = 5), skeletal dysplasia (n = 2), nonsyndromic upper airway obstruction (n = 2), and chronic neonatal lung disease (n = 1). The median (interquartile range) obstructive apnea-hypopnea index was 14 events/h (6.2-31 events/h) at CPAP initiation, which improved on CPAP to 3.4 events/h (1.4-6.4 events/h). The median (interquartile range) transcutaneous CO max remained unchanged on CPAP (56.6 mm Hg [49-66.5 mm Hg] pre-CPAP vs 54.9 mm Hg [47-62 mm Hg] on CPAP). Fifteen children needed surgical airway intervention (11 pre-CPAP and 4 post-CPAP). CPAP therapy could be successfully stopped in 9 children, 2 children needed tracheostomy, and 1 child died during the follow-up period.
Home CPAP as respiratory support is an effective long-term therapy in infancy, and these patients can be weaned from CPAP therapy even if it was initiated early. Prospective studies with predefined criteria for CPAP initiation and cessation would help ascertain long-term outcomes in this poorly researched group.
Joshi SS, Sivapalan D, Leclerc M-J, Kapur N. Home continuous positive airway pressure therapy in infants: a single-center experience. 2023;19(3):473-477.
关于婴儿期家庭持续气道正压通气（CPAP）治疗的适应证和结局，数据有限。我们旨在分析一组因睡眠呼吸障碍而开始家庭 CPAP 治疗并在婴儿期接受呼吸支持的患儿的临床、人口统计学和多导睡眠图特征。
回顾性评估在昆士兰儿童医院婴儿期开始 CPAP 的患儿的临床和人口统计学参数、潜在诊断、呼吸支持、气道手术干预以及基线和 CPAP 时的多导睡眠图结果。
共纳入 29 例婴儿（CPAP 起始时的中位年龄[四分位间距]，182 天[126-265.5 天]）。潜在病因包括 21 三体综合征（n=6）、颅面综合征（n=5）、肌张力低下（n=8；5 例无颅面综合征）、气道软化（n=5）、骨骼发育不良（n=2）、非综合征性上气道梗阻（n=2）和慢性新生儿肺疾病（n=1）。CPAP 起始时，中位（四分位间距）阻塞性呼吸暂停低通气指数为 14 次/小时（6.2-31 次/小时），CPAP 后改善至 3.4 次/小时（1.4-6.4 次/小时）。CPAP 时，中位（四分位间距）经皮二氧化碳最大值无变化（CPAP 前 56.6 毫米汞柱[49-66.5 毫米汞柱] vs CPAP 时 54.9 毫米汞柱[47-62 毫米汞柱]）。15 例患儿需要手术气道干预（11 例 CPAP 前，4 例 CPAP 后）。9 例患儿成功停止 CPAP 治疗，2 例患儿需要气管造口术，1 例患儿在随访期间死亡。
家庭 CPAP 作为呼吸支持是婴儿期有效的长期治疗方法，即使早期开始，也可以逐渐停用 CPAP 治疗。具有 CPAP 起始和停止预设标准的前瞻性研究将有助于确定这一研究不足人群的长期结局。
Joshi SS, Sivapalan D, Leclerc M-J, Kapur N. 婴儿家庭持续气道正压通气治疗：单中心经验。 2023;19(3):473-477.
