Background: Continuous positive airway pressure (CPAP) is frequently prescribed for patients with residual obstructive sleep apnea (OSA) following adenotonsillectomy.
Objectives: The goal was to examine the efficacy of noninvasive ventilation with average volume-assured pressure support (AVAPS) as a potential option for children with failed CPAP titration.
Methods: In a single-center retrospective study, we included children aged 1-17 years, with polysomnographically confirmed OSA who underwent AVAPS titration following failed CPAP titration. In addition to describing the clinical characteristics of the included patients, we compared polysomnographic parameters before and after AVAPS.
Results: Nine patients met the inclusion criteria; out of them, 8 (89%) were males with an age range of 6.7 ± 3.9 years and a body mass index percentile of 81.0 ± 28.9. Reasons for failed CPAP titration were: 3 (33%) patients due to inability to control apnea-hypopnea index (AHI), 3 (33%) patients due to sleep-related hypoventilation, 2 (22%) patients due to treatment-emergent central sleep apnea, and 1 (11%) patient due to intolerance to CPAP. AVAPS resulted in a greater reduction in AHI than CPAP (reduction following CPAP = 24.6 ± 29.3, reduction following AVAPS = 42.5 ± 37.6, p = 0.008). All patients had resolution of the problems which caused CPAP failure.
Conclusion: In this case a series of children with OSA and with failed CPAP titration, AVAPS resulted in a greater reduction in AHI compared with CPAP as well as resolution of the problems which caused CPAP failure.
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http://dx.doi.org/10.2174/18743064-v17-e230418-2022-18 | DOI Listing |
Pediatr Pulmonol
January 2025
Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
Objective: To investigate the effect of viral co-infections on treatment length and treatment failure in children with lower respiratory tract infections (LRTI) supported with continuous positive airway pressure (CPAP) or high-flow nasal cannula oxygenation therapy (HFNC).
Methods: Patients aged 0-5 years hospitalized with viral LRTI and in need of respiratory support between August 1 and December 31, 2021, were retrospectively evaluated by patient chart audits.
Results: A total of 148 children (median age 10.
J Prosthodont Res
January 2025
Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan.
Crit Care
November 2024
Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Background: High flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children ('step-up' RCT) and extubated children ('step-down' RCT). Clinical effectiveness findings (time to liberation from all forms of respiratory support) showed that HFNC was non-inferior to CPAP in the step-up RCT, but failed to meet non-inferiority criteria in the step-down RCT.
View Article and Find Full Text PDFSleep Med
January 2025
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. Electronic address:
Mean disease alleviation measures the effectiveness of Obstructive Sleep Apnea (OSA) treatments. It combines a patient's adherence to treatment normalized to their total sleep time and the treatment's efficacy as determined by the change in the apnea-hypopnea index. This metric fails to capture the patient's OSA-related symptoms, which are a key component and, in some cases, the primary component, of determining response to treatment.
View Article and Find Full Text PDFJ Clin Sleep Med
September 2024
Cliniques Universitaires Saint Luc, Center for Sleep Medicine, Université Catholique de Louvain, Brussels, Belgium.
A 72-year-old patient had a severe sleep apnea syndrome well controlled for many years through CPAP therapy. When switching to a newer device with upgraded functions, therapy completely failed. A video recording performed by the patient's wife showed high frequency mask movements suggesting inability to maintain a therapeutic pressure with high frequency pressure fluctuations, confirmed afterwards during full night polysomnography and in a bench study.
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