PURPOSE: Difficulty clearing respiratory secretions and frequent respiratory infections are common in children with cerebral palsy (CP) or neuromuscular disorders (NMD). Chest physiotherapy (CPT) is often recommended for treatment during acute respiratory illness as well as chronic management for pulmonary clearance. However CPT is labor-intensive and time consuming. High-frequency chest wall oscillation (HFCWO) has been used extensively in cystic fibrosis but only on a limited basis in CP and NMD patients. We evaluated these therapies to determine if consistent airway clearance would result in improved sleep-related outcomes.
METHODS: A prospective, randomized, controlled trial of HFCWO and CPT was performed. After randomization, patients were instructed to perform HFCWO or CPT t.i.d. for 3 months. Pre- and post-treatment measures from polysomnography (PSG) included sleep efficiency, apnea and hypopnea indices, and percent time SaO2 ≥90%.
RESULTS: 9 NMD and 4 CP subjects (ages 15.1±4.0) were randomized (6 CPT, 7 HFCWO) and completed pre- and post-treatment PSG. No therapy-related adverse events were seen. No outcome differences were seen between CPT and HFCWO groups. No differences in sleep efficiency or apnea events were observed after initiating airway clearance. Trends toward improvements in percent time SaO2 ≥90% (baseline median=97.8 [84.7-98.8 interquartile range], post-treatment 99.2 [97.1-99.8], p=0.07, Wilcoxon Signed Rank Test) and hypopnea index (baseline median=16.4 [0.6, 24.6], post-treatment 5.7 [2.2, 13.2], p=0.15) occurred.
CONCLUSION: Preliminary results suggest that consistent airway clearance may positively impact some sleep-related outcomes. Larger controlled studies are needed to evaluate the impact of airway clearance therapy on sleep and other efficacy outcomes.
CLINICAL IMPLICATIONS: HFCWO is an acceptable alternative to CPT in CP and NMD patients.
DISCLOSURE: Brian Becker, No Product/Research Disclosure Information; Employee I am an employee of the company sponsoring the trial.