Residual sleep disordered breathing under ventilatory support in children: a polysomnography study.

OBJECTIVES

To assess the effectiveness in children of long-term ventilatory support (VS) (continuous positive airway pressure [CPAP], non-invasive ventilation [NIV]), on symptoms, sleep, respiratory parameters using polysomnography (PSG), evaluate the prevalence of residual sleepiness and/or asthenia (RSA) under VS and identify parameters associated with RSA.

METHODS

Multicenter retrospective study including children with SDB aged between 1 month and 18 years, under long-term VS, evaluated by PSG, both at diagnosis in room air and under VS. Clinical, sleep, and respiratory characteristics were compared between diagnostic PSG and PSG under VS for the entire cohort and between patients with and without RSA.

RESULTS

A total of 61 children were included (median [IQR] age at diagnostic PSG and at PSG under VS, 7 [0-13] and 8 [0-13] years respectively). While the SDB night-time symptoms significantly improved with VS, the SDB daytime symptoms were not all well controlled; RSA under VS was present in 22/53 (42%) children. At PSG under VS compared to diagnostic PSG, non-respiratory arousal index remained abnormal despite significant improvement (median n = 15/hr [8-23] versus 21/h [12-29], p = 0.009) and OSA became mild (median OAHI 2/hr [1-4] versus 13/h [6-27], p < 0.001). Children with RSA, compared to children without RSA, more frequently used NIV than CPAP (82% versus 18%, p < 0.01) and had a lower proportion of rapid eye movement under VS (18% [14-25] versus 24% [20-32], p = 0.038).

CONCLUSION

While SDB symptoms improved under VS concurrent with the respiratory parameters, a significant proportion of children remained symptomatic with RSA, underlying the importance of carefully monitoring these patients during follow-up.