Home nasal continuous positive airway pressure in infants with sleep-disordered breathing.
OBJECTIVE
To review our experience with home nasal continuous positive airway pressure (CPAP) in infants with small upper airways and abnormal breathing during sleep.


METHODS
Seventy-four infants with sleep-disordered breathing and narrow upper airways, as identified by nocturnal polygraphic recording and endoscopic evaluation, were treated at home with nasal CPAP. Infants with craniofacial anomalies and trisomy 21, and infants who had been referred to us as having had "apparent life-threatening events," made up the majority of the population. Because of the rapid growth of infants, regular follow-up visits were scheduled to adjust CPAP and mask size.


RESULTS
Seventy-two infants were successfully treated at home with nasal CPAP; there were two failures. Follow-up lasted from 5 months to 12 years. Compliance was not a problem, but home nasal CPAP was prescribed only for infants who lived close to our center and whose families and pediatricians were willing to support compliance.


CONCLUSIONS
Home nasal CPAP requires careful, in-laboratory titration and regular follow-up to adjust both pressure and mask size. With the support of families and pediatricians, home nasal CPAP can be an effective treatment for infants with upper airway respiratory problems during sleep. In many cases, it can provide an interim solution, enabling physicians to plan surgery at an appropriate time and giving infants time to grow before having to undergo surgical stress.
Sleep Disorders Clinic, Stanford University, Palo Alto, California 94304, USA.
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Guilleminault
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Pelayo
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Clerk
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Leger
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Bocian
D000402:Airway Obstruction / Q000150:complications; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010349:Patient Compliance; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D012140:Respiratory Tract Diseases / Q000150:complications / Q000175:diagnosis; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012895:Sleep, REM