Home continuous positive airway pressure treatment for obstructive sleep apnoea in Infants: A single centre experience

Abstract

Introduction/Aim: There is limited data on management and outcomes of obstructive sleep apnoea (OSA) in the first year of life. We aimed to analyze the clinical, demographic and polysomnographic (PSG) characteristics of children who were initiated on home continuous positive airway pressure (CPAP) for treatment of OSA in the first year of life. Methods: Children started on CPAP for OSA in the first year of life at the Queensland Children's Hospital were retrospectively studied. Data evaluated included: clinical & demographic parameters, underlying diagnoses, respiratory support prior to CPAP therapy, airway surgical intervention if any and PSG results at baseline and on CPAP. Results: From November 2011-October 2018, 29 infants [median age(IQR) 182 days(126-265.5)] 12F; were initiated on CPAP. Underlying aetiology included craniofacial syndromes [Trisomy 21(n=6), Crouzon's syndrome(n=2), Phelan- McDermid syndrome, Goldenhar Syndrome, Smith-Magenis syndrome, Poland-Moebius syndrome, Pfeiffer's syndrome, Pierre-Robin syndrome (1 of each), others(n=5)], skeletal dysplasia(n=2) and airway malacia(n=8). 18(62%) infants required respiratory support (supplementary oxygen in 14, NPT in 1 and both in 3) prior to CPAP initiation. The median(IQR) Obstructive Apnoea-Hypopnea Index was 14(6.2-31) at CPAP initiation, which improved to 3.4(1.4-6.4) on CPAP. Median(IQR) TcCo2 max was 56.6(49-66.5)mm at CPAP initiation, which with no significant change on CPAP [54.9(47-62 mm)]. 17 children needed surgical airway intervention (13 pre-CPAP initiation and 4 post). 15(52%) children were still using CPAP therapy with 9 successfully weaned, 2 tracheostomized, 2 were non-tolerant and 1 child with Poland-Moebius syndrome had died. Conclusion: Home CPAP therapy is an effective way management strategy in severe OSA in infancy. CPAP therapy can be weaned even if initiated early. Prospective studies with pre-defined criteria for CPAP initiation and cessation would help ascertain long term outcomes in this poorly researched group.L6350678952021-05-28 <br />