Symptom care approach to noninvasive ventilatory support in children with complex neural disability

Abstract

Study Objectives: Sleep-disordered breathing is a major cause of morbidity and mortality among pediatric patients with severe neurological disabilities such as cerebral palsy. Despite increasing use of noninvasive ventilation (NIV) in this group, there remains a lack of consensus about its role and indications. We aim to explore the indications, acceptability, and outcomes of a cohort of children with severe, complex neurological disability and sleep-disordered breathing, managed with NIV.; Methods: Data were retrospectively extracted on children with severe neurological disabilities (Gross Motor Function Classification System V equivalent) initiated on NIV in Queensland over a 5-year period. Demographic, clinical, hospitalization, and polysomnography data were collected, as well as caregiver-reported side effects and NIV adherence.; Results: Fourteen (median age 9.1 years; 6 female) children were included, 8 with cerebral palsy and 6 with other complex neurological disabilities. Obstructive sleep apnea was the most common indication for NIV (n = 12). The median (interquartile range) apnea-hypopnea index improved on NIV [pre-NIV 21.3 (interquartile range 10.0-28.2) vs post-NIV 12.2 (interquartile range 2.8-15.2)], although this was not statistically significant. There was significant improvement in proportion of time spent with SpO 2 < 95% (22.2% pre-NIV vs 7.85% post-NIV; P < .05). Reported side effects were minimal. There was no reduction in hospital admissions in the 12 months post-NIV initiation.; Conclusions: Our findings suggest that NIV improves polysomnography parameters among children with severe neurological disability. Long-term outcomes and overall impact on quality of life remain unclear. Ethical issues and overall benefit must be considered before embarking on this mode of therapy.; Citation: Morrison L, Suresh S, Leclerc MJ, Kapur N. Symptom care approach to noninvasive ventilatory support in children with complex neural disability. J Clin Sleep Med . 2022;18(4):1145-1151. (© 2022 American Academy of Sleep Medicine.)Rev Port Pneumol. 2014 May-Jun;20(3):146-51. (PMID: 24525398); BMJ Open. 2015 Aug 12;5(8):e008697. (PMID: 26270951); Respirology. 2021 Oct;26(10):920-937. (PMID: 34387937); Breathe (Sheff). 2016 Dec;12(4):e97-e103. (PMID: 28210329); Arch Dis Child. 1986 Feb;61(2):178-81. (PMID: 3954442); Sleep Med Rev. 2012 Dec;16(6):561-73. (PMID: 22609124); Front Pediatr. 2020 Oct 26;8:544921. (PMID: 33194886); Arch Dis Child. 2018 Dec;103(12):1170-1177. (PMID: 29886412); Pharmacotherapy. 2016 Jan;36(1):84-98. (PMID: 26799351); South Med J. 2021 Jun;114(6):339-342. (PMID: 34075423); Paediatr Respir Rev. 2009 Mar;10(1):18-24. (PMID: 19203740); Dev Med Child Neurol. 1997 Apr;39(4):214-23. (PMID: 9183258); Dev Med Child Neurol. 2017 Apr;59(4):420-426. (PMID: 27779314); Res Dev Disabil. 2008 Mar-Apr;29(2):133-40. (PMID: 17331700); Pediatr Pulmonol. 2014 Aug;49(8):816-24. (PMID: 24000198); Acta Paediatr. 2009 Nov;98(11):1809-14. (PMID: 19627261); Arch Dis Child. 2003 Jan;88(1):75-8. (PMID: 12495971); Sleep Med. 2011 Mar;12(3):252-6. (PMID: 21334973); Sleep Breath. 2015 May;19(2):421-32. (PMID: 25404374); Lancet. 2014 Apr 5;383(9924):1240-9. (PMID: 24268104); Breathe (Sheff). 2016 Dec;12(4):357-363. (PMID: 28270864); Dev Med Child Neurol. 2012 Apr;54(4):353-60. (PMID: 22329739); Front Pediatr. 2020 Jun 24;8:333. (PMID: 32671000); Thorax. 2005 Dec;60(12):1019-24. (PMID: 16299118); Minerva Anestesiol. 2011 Sep;77(9):892-901. (PMID: 21878871); Am J Respir Crit Care Med. 2012 May 1;185(9):998-1003. (PMID: 22323303). Linking ISSN: 15509389. Subset: MEDLINE; Date of Electronic Publication: 20220401. ; Original Imprints: Publication: Darien, IL : American Academy of Sleep Medicine, 2005- <br />