Compliance rates in children using noninvasive continuous positive airway pressure.

STUDY OBJECTIVES: For a subpopulation of children with obstructive sleep apnea, the mainstay of treatment is nasal continuous positive airway pressure (nCPAP). Accurate measures of "time in use" have not been used to assess compliance with nCPAP in large numbers of children. Data from a comprehensive nCPAP program are used to describe nCPAP use among children aged 6 months to 18 years and provide time-in-use compliance rates. DESIGN: Retrospective cohort study SETTING: University Pediatric Teaching Hospital INTERVENTIONS: Initiation of nCPAP treatment MEASUREMENTS AND RESULTS: Seventy-nine children were identified as requiring treatment with nCPAP, with 65 (82%) successfully established on nCPAP during the 46-month study period. Objective compliance data were available on 50 children: 66% were boys, 78% had a complicating medical disorder, the mean age was 10 +/- 5.1 years, and the median apnea-hypopnea index was 11.3 (interquartile range, 5.4-25.9). Follow-up ranged from 8 to 979 days. Forty-eight percent of children used nCPAP immediately. Seventy-six percent of children used nCPAP for at least half the days, with use defined as 1 or more hours of recording during a 24-hour period. Mean daily use was 4.7 hours (interquartile range, 1.4-7.0), and mean daily use on days nCPAP was used was 6.3 hours (interquartile range, 3.3-8.5) CONCLUSIONS: With patience, a behavioral modification approach, and parental commitment, children will be accepting of nCPAP and reasonably compliant with treatment.

Continuous positive airway pressure for children: a discussion on how to maximize compliance.

As pediatric sleep facilities and resources expand, increasing numbers of children with sleep-disordered breathing requiring continuous positive airway pressure (CPAP) treatment are being identified. Despite extensive expertise in treating adults with CPAP, many centres have little experience using CPAP in the pediatric population. The successful initiation and continued effective treatment with CPAP requires a unique and specialized approach to the pediatric patient and their family. Nearly, half of children needing CPAP will be uncooperative upon initial exposure to this unusual treatment. This review aims to outline an approach to the successful initiation of CPAP treatment in children including some trouble-shooting strategies to maximize initial and ongoing compliance with prescribed therapy.

Mandibular dimensions in children with obstructive sleep apnea syndrome.

OBJECTIVE: We hypothesized that mandibular size may play a role in the etiology of obstructive sleep apnea syndrome (OSAS) in children, since a smaller mandible may reduce airway size. We used magnetic resonance imaging to determine the mandible dimensions of children with OSAS. DESIGN: Case control study. SETTING: Tertiary-care pediatric hospital. PARTICIPANTS: Twenty-four subjects (mean age 4.9 +/- 1.7 years) with mild to moderate OSAS (Apnea Index 3.5 +/- 5.1), and 24 matched controls (mean age 4.9 +/- 1.8 years). INTERVENTION: Magnetic resonance imaging of the upper airway under sedation. MEASUREMENTS: Eight measurements were obtained from a 3-dimensional segmentation of the mandible using 3DVIEWNIX software. Measurements included length, height, width, midsymphysis menti angle, angle of mandible, enclosure area, surface area, and volume. Descriptive comparisons using Student t test and multivariate analyses of variance were performed. RESULTS: Individual measurement comparisons revealed no significant differences between groups. Multivariate analysis showed a lower bound of a 95% confidence interval for an effect size measure for "general mandibular size," including all 6 linear, the area, and the volume measurements, to be -0.25. CONCLUSION: Our study shows that a smaller mandible is not a feature in children with OSAS who do not have apparent craniofacial abnormalities.

Age-specific relationship between CD14 and atopy in a cohort assessed from age 8 to 25 years.

CD14 influences postnatal switching of T helper cell responses. CD14 C-159T has been associated with altered CD14 and IgE levels in cross-sectional studies. Identifying whether associations vary with age requires data from children of the same age followed longitudinally over many years. In this study, an unselected population with extensive longitudinal data was used to test the hypothesis that CD14 C-159T was associated with early-onset atopy. A total of 305 subjects were assessed on up to seven occasions between ages 8 and 25 years by questionnaire, histamine challenge, and skin prick test. For atopy, airway hyperresponsiveness (AHR), and wheeze, each subject was classified as having early onset, late onset, or no disease onset during follow-up. Compared with subjects with -159CT and -159TT, subjects with -159CC had an odds ratio of 2.2 (p = 0.018) for early-onset atopy and an odds ratio of 2.6 (p = 0.019) for early-onset AHR. Cross-sectional analysis showed increased prevalence of -159CC in subjects with atopy and AHR in childhood but not adulthood. These data suggest that the influence of CD14 -159C on the atopic phenotype may be age specific, exerting an effect during midchildhood, which is no longer apparent by early adulthood.