Study objectives: To assess the efficacy of continuous
positive airway pressure (CPAP) in obstructive sleep apnea (OSA)
patients who are < 2 years of age.
retrospective chart review of 18 patients from 1992 to 1999 who had OSA
confirmed by polysomnography. All patients in this study also
completed a separate night of CPAP polysomnography to
determine the effectiveness of CPAP in the correction of OSA. Nasal
CPAP compliance data were gathered via clinical follow-up examination,
telephone interview, or mailed questionnaire.
All patients were studied in the Sleep Disorders Center at Loma Linda
University Children’s Hospital in Loma Linda, CA.
Patients: All patients were < 2 years old.
Intervention: After OSA was confirmed by the results of
technician-attended nocturnal polysomnography, separate
technician-attended nocturnal CPAP polysomnography was completed. On
CPAP nights, CPAP pressure was titrated to ameliorate OSA and snoring.
CPAP pressure was increased by 2-cm H2O or 1-cm
Results: Data were
analyzed by dependent groups t test at p < 0.05 level
of significance. CPAP statistically improved respiratory parameters
significantly when compared to baseline polysomnography. The following
four patient subgroups emerged from the analysis: group 1 consisted of
six patients who had tracheostomies prior to the CPAP trial, with two
patients using CPAP as an alternative to tracheostomy; group 2
consisted of two patients who had previous unsuccessful
adenostonsillectomies and who used CPAP successfully, with both
having OSA resolution over time; group 3 consisted of four patients who
did not tolerate CPAP on the study night; and group 4 consisted of six
patients who used CPAP nightly, had OSA resolution over time, and
therefore, no longer needed CPAP therapy. Thus, 10 of 18 patients used
CPAP either on an interim basis for corrective therapy or as a primary
treatment modality for OSA.
Conclusions: These data
show that children < 2 years of age can tolerate and use CPAP
effectively. In several cases, CPAP treatment could be discontinued as
OSA resolved over time. The reasons for this are discussed in the