CPAP for pediatric obstructive sleep apnea
- Ann C Halbower, MD
Ann C Halbower, MD
- Professor, Pediatric Pulmonary Section
- University of Colorado School of Medicine and Children's Hospital Colorado
Continuous positive airway pressure (CPAP) therapy is one of several options for treatment of obstructive sleep apnea (OSA) in children. The goals of CPAP therapy are to ensure unobstructed breathing, good sleep quality, improved daytime function, and in some cases, rest from work of breathing. CPAP can be used temporarily between facial surgeries, while the child grows, or chronically in the presence of a craniofacial malformation or other anatomical predisposition for obstruction . When started early in the course of OSA, CPAP therapy should mitigate the associated cardiovascular risk.
The challenges of CPAP titration in children are illustrated by the following vignette: A six-year-old obese male with OSA undergoes CPAP titration. The sleep technologist increases the pressure progressively from 6 to 15 cm H20 pressure with continued signs of paradoxical breathing, snoring, gasping, and increased leak measured on the polysomnogram (waveform 1). The technologist then switches the mode to bilevel ventilation with no change in the respiratory distress. The child arouses frequently and wakes up crying refusing to complete the study. What was the cause of failure in this CPAP titration?
This topic review will discuss a proactive approach to initiating CPAP therapy in children, including desensitization, equipment selection, promoting adherence to therapy, and troubleshooting problems. Other issues related to OSA in children are discussed in the following topic reviews:
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- TREATMENT DECISIONS
- PREPARING THE ANATOMY FOR SUCCESSFUL AIRFLOW
- FIRST STEPS IN CPAP INTRODUCTION
- Forming a partnership
- The PAP nap
- THE CPAP PRESCRIPTION
- Choosing the right equipment
- - Patient-device interface
- - Humidifiers
- - Auto-CPAP
- - Bilevel PAP
- Titration of CPAP in children
- MEDICAL FOLLOW-UP OF CHILDREN USING CPAP THERAPY
- Follow-up visits and monitoring
- When to repeat a CPAP titration
- Barriers to effective CPAP therapy in children
- CPAP NONRESPONDERS
- SUMMARY AND RECOMMENDATIONS