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ABSTRACT
Introduction
Obstructive sleep apnea (OSA) is an important and evolving area in the pediatric population, with significant sequelae when not adequately managed. The use of positive airway pressure (PAP) therapy is expanding rapidly and is being prescribed to patients with persistent OSA post adenotonsillectomy as well as those children who are not surgical candidates including those with medical complexity.
Areas discussed
This article provides a state-of-the-art review on the diagnosis of pediatric OSA and treatment with positive airway pressure (PAP). The initiation of PAP therapy, pediatric interface considerations, PAP mode selection, administration and potential complications of PAP therapy, factors influencing PAP adherence, the use of remote ventilation machine downloads, considerations surrounding follow-up of patients post PAP initiation and evaluation of weaning off PAP will be reviewed. The literature search was conducted via PubMed, Cochrane Library and Google Scholar databases through to March 2024.
Expert opinion
Further research is required to address barriers to adherence. Further innovation of home monitoring devices for both the diagnosis and assessment of OSA is required, given the limited pediatric sleep medicine resources in several countries worldwide.
Article highlights
Obstructive sleep apnea is a common diagnosis in pediatrics.
Adenotonsillectomy is the first-line treatment for OSA in children.
Positive airway pressure (PAP) therapy is frequently prescribed in children to treat persistent OSA post adenotonsillectomy or those children that are not surgical candidates.
There are various interfaces and positive airway pressure modes available.
Regular follow-up is required post PAP commencement to ensure efficacy and adherence.
Adherence to PAP therapy in children remains low and a multi-disciplinary approach is often necessary.
Abbreviations
| AHI | = | Apnea-Hypopnea Index |
| APAP | = | Automatic Positive Airway Pressure |
| BMI | = | Body Mass Index |
| BPAP | = | Bi-level Positive Airway Pressure |
| CNS | = | Central Nervous System |
| CPAP | = | Continuous Positive Airway Pressure |
| DISE | = | Drug-induced Sleep Endoscopy |
| EPAP | = | Expiratory Positive Airway Pressure |
| HFNC | = | Heated High-flow Nasal Cannula |
| IPAP | = | Inspiratory Positive Airway Pressure |
| MSK | = | Musculoskeletal |
| NIV | = | Non-invasive Ventilation |
| NMD | = | Neuromuscular Disorders |
| AHI | = | Obstructive Apnea-Hypopnea Index |
| OSA | = | Obstructive Sleep Apnea |
| PSG | = | Polysomnography |
| SaO2 | = | Oxygen Saturation |
| tcCO2 | = | Transcutaneous Carbon Dioxide |
| VAPS | = | Volume Assured Pressure Support |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.