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. 2021 Feb;159(2):810-817.
doi: 10.1016/j.chest.2020.08.020. Epub 2020 Aug 15.

Positive Airway Pressure for the Treatment of OSA in Infants

Christopher M Cielo  1 , Patricia Hernandez  2 , Alyssa M Ciampaglia  3 , Melissa S Xanthopoulos  4 , Suzanne E Beck  5 , Ignacio E Tapia  5
Affiliations

Positive Airway Pressure for the Treatment of OSA in Infants

Christopher M Cielo et al. Chest. 2021 Feb.

Abstract

Background: Positive airway pressure (PAP) is a standard therapy for the treatment of OSA in children, but objective data on the effectiveness of PAP in infants are sparse. The aim of this study was to compare the effectiveness of PAP in infants younger than 6 months of age with that in school-aged children.

Research question: Compared with PAP in school-aged children, can PAP be titrated as successfully in infants, and is adherence to PAP similar in both age groups?

Study design and methods: Single-center retrospective study. For consecutive infants younger than 6 months of age and school-aged children 5 to 10 years of age with OSA treated with PAP, baseline and titration polysomnography data, PAP adherence data, and parent-reported barriers to adherence were compared between groups.

Results: Forty-one infants and 109 school-aged children were included. Median obstructive apnea hypopnea index (OAHI) in infants was 25.7/h (interquartile range [IQR], 17.8-35.9/h) and was greater than that in school-aged children (12.1/hr; IQR, 7.6-21.5/h; P < .0001). After PAP titration, OAHI was reduced by a median of 92.1% in infants, similar to the median 93.4% reduction in school-aged children (P = .67). PAP was used in infants on 94.7% of nights, which was more than the 83% in school-aged children (P = .003). No differences were found in barriers to adherence between infants and school-aged children, with behavioral barriers being most common in both groups.

Interpretation: Objective data demonstrate that PAP is both highly effective at treating OSA and well-tolerated in infants. Like older patients, PAP should be considered along with other therapies for the treatment of OSA in even the youngest children.

Keywords: CPAP; OSA; pediatrics.

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Figures

Figure 1
Figure 1
Flow diagram showing participants included in the final analysis. PAP = positive airway pressure.
Figure 2
Figure 2
A, B, Graphs showing change in OAHI in infants and school-aged children treated with PAP. For infants (A), median reduction in OAHI was 92.1% on the final PAP setting. For school-aged children (B), median reduction in OAHI was 93.4%. OAHI = obstructive apnea hypopnea index. See Figure 1 legend for expansion of other abbreviation.
Figure 3
Figure 3
Infant and father sleeping with CPAP at home. Photograph used with permission.
See this image and copyright information in PMC

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