Nasal continuous positive airway pressure use in children with obstructivesleep apnea younger than 2 years of age

Study objectives: To assess the efficacy of continuous positive airway pres sure (CPAP) in obstructive sleep apnea (OSA) patients who are < 2 years of age. Design: A retrospective chart review of 18 patients from 1992 to 1999 who h ad OSA confirmed by polysomnography. All patients in this study also comple ted a separate night of CPAP polysomnography to determine the effectiveness of CPAP in the correction of OSA. Nasal CPAP compliance data were gathered via clinical follow-up examination, telephone interview, or mailed questio nnaire. Setting: All patients were studied in the Sleep Disorder Center at Loma Lin da University Children's Hospital in Loma Linda, CA. Patients: All patients were < 2 years old. Intervention: After OSA was confirmed by the results of technician-attended nocturnal polysomnography, separate technician-attended nocturnal CPAP pol ysomnography was completed. On CPAP nights, CPAP pressure was titrated to a meliorate OSA and snoring. CPAP pressure was increased by 2-cm H2O or 1-cm H2O increments. Results: Data were analyzed by dependent groups t test at p < 0.05 level of significance. CPAP statistically improved respiratory parameters significa ntly when compared to baseline polysomnography. The following four patient subgroups emerged from the analysis: group 1 consisted of six patients who had tracheostomies prior to the CPAP trial, with two patients using CPAP as an alternative to tracheostomy; group 2 consisted of two patients who had previous unsuccessful adenostonsillectomies and who used CPAP successfully, with both having OSA resolution over time; group 3 consisted of four patie nts who did not tolerate CPAP on the study night; and group 4 consisted of six patients who used CPAP nightly, had OSA resolution over time, and there fore, no longer needed CPAP therapy. Thus, 10 of 18 patients used CPAP eith er on an interim basis for corrective therapy or as a primary treatment mod ality for OSA. Conclusions: These data show that children < 2 years of age can tolerate an d use CPAP effectively. In several cases, CPAP treatment could be discontin ued as OSA resolved over time. The reasons for this are discussed in the te xt.