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持续气道正压(CPAP)治疗儿童阻塞性睡眠呼吸暂停

Author
Ann C Halbower, MD
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
Alison G Hoppin, MD
Translators
龚敬宇, 副主任医师

引言

持续气道正压(continuous positive airway pressure， CPAP)是儿童阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)的治疗方法之一。CPAP治疗的目的是确保呼吸通畅、提高睡眠质量、改善白天功能，对于部分病例还可减少呼吸功。CPAP可临时用于儿童成长发育过程中的两次面部手术之间，或是长期用于颅面部畸形或其他容易引起气道梗阻的解剖因素[1]。如果在OSA早期开始CPAP治疗，可减轻相关心血管疾病的风险。

以下内容阐述了在儿童中进行CPAP压力滴定的困难：一例存在OSA的6岁肥胖男孩接受了CPAP压力滴定。睡眠技师将压力从6逐渐增加至15cmH20，经睡眠多导图测量发现该儿童有持续的矛盾呼吸、打鼾、喘息和漏气增加的征象(波形 1)。然后技师将通气模式改为双水平通气模式，呼吸窘迫情况并没有发生改变。在这一过程中该儿童频繁觉醒并且醒后哭闹拒绝完成整个研究。是什么导致了这次CPAP压力滴定的失败呢？

本专题将讨论在儿童中开始CPAP治疗的前瞻性方法，包括如何适应治疗、选择设备、提高治疗依从性和解决问题。其他有关儿童OSA的问题在以下专题中讨论：

●(参见“儿童疑似阻塞性睡眠呼吸暂停的评估”)

●(参见“儿童阻塞性睡眠呼吸暂停的治疗”)

                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-16.
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