Efficacy of Automated Continuous Positive Airway Pressure in Children With Sleep-Related Breathing Disorders in an Attended Setting Luciana Palombini, MD; Rafael Pelayo, MD; and Christian Guilleminault, MD ABSTRACT. Introduction. The purpose of this study was to evaluate the safety and efficacy of automated con- tinuous positive airway pressure (Auto-CPAP) in children. Sleep-related breathing disorders (SRBDs) include the clinical spectrum of symptomatic chronic snoring, upper airway resistance syndrome, and obstructive sleep apnea. This spectrum occurs in adults and children. Less data are available for children despite recognition of the con- dition’s prevalence. CPAP has been an established treat- ment for adults and children. Treatment with Auto-CPAP has been available for adults but has not been reported previously in children. Methods. A group of 14 children (8 months to 12 years old) was evaluated prospectively with baseline polysom- nographic study and CPAP titration performed with Au- to-CPAP under sleep technologist supervision. Results. The results demonstrated that Auto-CPAP is sensitive and effective for children with obstructive sleep apnea in an attended setting. There was 1 subject who did not seem to tolerate Auto-CPAP, but when she was switched to conventional CPAP, she did not tolerate that either. In this subject, the mask never fit well. She was excluded from the analysis. All other patients had a decrease in the number of abnormal breathing events during sleep. The respiratory disturbance index de- creased from a mean of 12.6 (SD: 12.4) to 2.6 (SD: 2.7) events per hour. The lowest oxygen saturation improved from a mean of 86% (SD: 10.8) to 93.6% (SD: 3.9). Conclusions. We conclude that Auto-CPAP is safe and effective in an attended environment. Auto-CPAP did not eliminate all the abnormal respiratory events. In subjects 1 and 14, the final respiratory index improved but remained >5 events per hour (5.9 and 7.7, respec- tively). We suspect that this was because of problems with the masks leaking, which illustrates the importance of follow-up and possible need for retitration in some patients. Proper mask fit is essential for successful treat- ment. Additional work is needed to evaluate its utility in the home setting. This study was designed to evaluate Auto-CPAP titration in an attended environment. It did not indicate information about the effectiveness in an unattended or home setting. We demonstrate that Auto- CPAP is able to detect abnormal breathing events during sleep in children and may provide the necessary pressure to correct these events. Auto-CPAP can be used safely for pressure titration in an attended setting. Auto-CPAP de- vices from different manufactures are commercially available for adults. These different devices may have different algorithms and sensitivities to detect abnormal breathing episodes. This study was performed with only 1 specific model of Auto-CPAP. Our results should not be extrapolated to other Auto-CPAP devices without em- pirical confirmation of the devices’ ability to detect and correct events in children. Auto-CPAP can be an alterna- tive treatment for SRBDS in the pediatric population. These results allow for speculation of possible applica- tions for Auto-CPAP in children. A potential advantage of Auto-CPAP includes permitting the initiation of treat- ment while awaiting a standard CPAP titration. The vari- able pressure response of Auto-CPAP allows for treat- ment under different situations such as upper airway infections, different sleeping positions, and changes in weight. As the child grows, the amount of positive pres- sure needed to maintain airway patency may change. Auto-CPAP may be able to adjust to these changing pressure requirements. Auto-CPAP does not eliminate the need for periodic office visits and evaluations of the clinical course. Pediatrics 2004;113:e412–e417. URL: http://www.pediatrics.org/cgi/content/full/113/5/e412; sleep, breathing, obstructive sleep apnea, child, treatment, oxygen saturation, snoring, CPAP. ABBREVIATIONS. SRBD, sleep-related breathing disorder; CPAP, continuous positive airway pressure; Auto-CPAP, auto- mated CPAP; Sao 2 , arterial oxygen saturation; RDI, respiratory disturbance index. I n children, sleep-related breathing disorders (SRBDs) are estimated to occur in 2% to 6% of the population. 1 Consequences of SRBDs in children include car- diovascular complications. 2–5 In addition to the car- diovascular consequences, behavioral changes have been associated with SRBDs and may include irrita- bility, aggressiveness, hyperactivity, and disciplinary problems. Several studies have demonstrated a high incidence of impaired school performance, hyperac- tivity, decreased intellectual performance, and emo- tional problems associated with SRBDs in children. 6–9 SRBD symptoms were associated with attention-def- icit/hyperactivity disorder in a cross-sectional study involving 866 children. 10 Treatment options for children with SRBDs typi- cally are surgery and continuous positive airway pressure (CPAP). Oral appliances are available for adults but are not routinely used in children. Surgery (adenotonsillectomy) is the most common form of treatment in children. The cure rate with surgery is unknown, but improvement of the condition has been reported at 85% by Suen et al. 11 In the presence of craniofacial or neurologic problems, the effective- ness of surgery may be lower. 12 From the Department of Psychiatry, Stanford Sleep Disorders Clinic, Stan- ford University School of Medicine, Stanford, California. Received for publication Jun 23, 2003; accepted Dec 16, 2003. Address correspondence to Rafael Pelayo, MD, Stanford University Sleep Disorders Clinic, 401 Quarry Rd, Ste 3301, Stanford, CA 94305. E-mail: pelayo@stanford.edu. PEDIATRICS (ISSN 0031 4005). Copyright © 2004 by the American Acad- emy of Pediatrics. e412 PEDIATRICS Vol. 113 No. 5 May 2004 http://www.pediatrics.org/cgi/content/full/113/5/e412 by guest on January 9, 2018 http://pediatrics.aappublications.org/ Downloaded from