Marcus C L, Ward S L, Mallory G B, Rosen C L, Beckerman R C, Weese-Mayer D E, Brouillette R T, Trang H T, Brooks L J
Johns Hopkins University, Baltimore, Maryland 21287-2533, USA.
J Pediatr. 1995 Jul;127(1):88-94. doi: 10.1016/s0022-3476(95)70262-8.
To determine the safety and efficacy of nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) during childhood and the effects of growth and maturation on CPAP requirements.
Retrospective study with use of a written questionnaire administered to pediatric practitioners treating sleep disorders.
Nine academic pediatric sleep disorders centers.
Data were obtained for 94 patients. Three percent of patients receiving CPAP were less than 1 year, 29% were 1 to 5 years, 36% were 6 to 12 years, and 32% were 13 to 19 years of age; 64% were boys. The longest duration of CPAP use was 4 years. Indications for CPAP included OSA associated with obesity (27%), craniofacial anomalies (25%), idiopathic OSA persisting after adenoidectomy and tonsillectomy (17%), and trisomy 21 (13%). Continuous positive airway pressure was effective in 81 patients (86%), in one patient it was unsuccessful, and in 12 patients compliance was inadequate. The median pressure required was 8 cm H2O (range, 4 to 20 cm H2O); pressure requirements were independent of age or diagnosis. Twenty-two percent of patients eventually required a modification of CPAP levels. Complications of CPAP were minor. Sixty-four percent of centers reported difficulty in obtaining funding for CPAP.
Continuous positive airway pressure is safe, effective, and well tolerated by children and adolescents with OSA. Experience in infants is limited. As pressure requirements change with patient growth, we recommend that CPAP requirements be regularly reevaluated over time. The marked center-to-center variability in CPAP use suggests that specific indications for this therapy require clarification.
确定儿童阻塞性睡眠呼吸暂停（OSA）患者使用鼻持续气道正压通气（CPAP）的安全性和有效性，以及生长发育对CPAP需求的影响。
采用书面问卷对治疗睡眠障碍的儿科医生进行回顾性研究。
九个学术性儿科睡眠障碍中心。
获取了94例患者的数据。接受CPAP治疗的患者中，3%年龄小于1岁，29%为1至5岁，36%为6至12岁，32%为13至19岁；64%为男孩。CPAP使用的最长持续时间为4年。CPAP的适应证包括与肥胖相关的OSA（27%）、颅面畸形（25%）、腺样体切除和扁桃体切除后持续存在的特发性OSA（17%）以及21三体综合征（13%）。81例患者（86%）使用CPAP有效，1例无效，12例依从性不足。所需的中位压力为8 cm H₂O（范围为4至20 cm H₂O）；压力需求与年龄或诊断无关。22%的患者最终需要调整CPAP水平。CPAP的并发症较轻微。64%的中心报告在获取CPAP资金方面存在困难。
持续气道正压通气对患有OSA的儿童和青少年是安全、有效的，且耐受性良好。婴儿方面的经验有限。由于压力需求随患者生长而变化，我们建议随时间定期重新评估CPAP需求。CPAP使用在中心之间存在显著差异，这表明该治疗的具体适应证需要明确。
