Advice To Children With Sleep Apnea: Wear That Night-time Breathing Device!

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Advice To Children With Sleep Apnea: Wear That Night-time Breathing

Device!

http://www.medicalnewstoday.com/medicalnews.php?newsid=39479

Wearing a special mask to bed helps children with sleep apnea breathe

and sleep better, but a small, six-month study at s Hopkins

Children's Center and two other pediatric hospitals suggests children

aren't always using them consistently enough to reap the maximum

benefits.

The breathing masks, which deliver a gentle, steady flow of air

called positive airway pressure (PAP) therapy, significantly improved

breathing and oxygen levels when worn regularly, researchers report

in the March issue of Pediatrics. Parents also reported that their

children had improved daytime alertness at school. Sleep apnea is

marked by loud snoring and disturbed sleep caused by interrupted

breathing patterns.

" Despite improvements with even irregular use of the device, parents

often say children are using PAP when the study shows they are not, "

says investigator Ann Halbower, M.D., pediatric pulmonologist at the

s Hopkins Children's Center. " Obstructive sleep apnea can cause

learning, memory and IQ problems. Additionally, it affects breathing

and oxygen levels, and while PAP therapy helps the apnea, the maximum

benefits come only over time and with consistent use. "

For the study, researchers enrolled 29 children between 2 and 16

years of age and instructed them to use the PAP masks at home every

night. The 29 children underwent a baseline sleep study at

enrollment, and 20 of them returned for a follow-up sleep study after

six months. In addition, investigators surveyed the parents of the 20

children who completed the study to get their account of usage, and

also tallied recorded usage data built into the PAP devices.

Comparing baseline and follow-up measures, researchers found a nine-

fold average decrease in children's apnea hypopnea index (AHI), which

represents the number of interruptions in breathing per hour. Oxygen

saturation improved by an average 12 percent.

" What this means is that with treatment, sleep apnea basically went

from severe to mild or better, " Halbower says.

It remains unclear how PAP therapy affects neurocognitive

performance, even though parents reported improved alertness and

dramatic reduction in the percentage of children who fell asleep

during school at least once a week. Halbower cautions that these

outcomes are based on subjective reports, and further studies are

needed to document objectively the device's effect on neurocognitive

function. There was no difference in reported academic performance,

irritability or hyperactivity.

Comparing parents' reports and data obtained from the device's

computerized meter, researchers found that parents tended to

overestimate usage by approximately two hours. Even those who used

the equipment every night only did so for an average of five hours a

night, which is insufficient, given children's long sleep hours,

Halbower says. In addition, 78 percent of parents told researchers

that their children did not use the equipment every night.

The study did not address reasons for non-adherence to PAP therapy.

Halbower says further studies are needed to examine reasons for non-

adherence and to develop treatments for those children who cannot

tolerate PAP.

Obstructive sleep apnea syndrome affects 2 percent of children in the

United States. It occurs because of partial or complete obstruction

of the airways during sleep due to anatomic and/or neuromotor

factors. In children, the leading cause of sleep apnea is enlarged

tonsils and adenoids, and the first line of treatment is surgical

removal. If untreated, sleep apnea may lead to serious problems in

later life, including hypertension, cardiovascular disease, diabetes

and increased mortality.

The study's principal investigator is Carole Marcus, M.D., Children's

Hospital of Philadelphia.

Co-investigators included Sterni, M.D., assistant professor of

pediatric pulmonology, and Janita Lutz, both of s Hopkins

Children's Center; Gerald Rosen, M.D., and Pamela Stading, M.D.,

University of Minnesota School of Medicine; Sally son Ward,

M.D., and Daisy Bolduc, M.D., University of Southern California

School of Medicine; and Gordon, of Gordon & Associates,

consultant to ResMed Corp, a manufacturer of respiratory medical

devices.