title: An adverse effect of positive airway pressure on the upper airway documented with magnetic resonance imaging.
abstract: OBJECTIVE
  Positive pressure air is used during basic life support to provide respirations and applied as continuous positive airway pressure to maintain a patent airway during sleep or anesthesia. These functions are more critical in children with obstructive sleep apnea, who often have smaller airway dimensions and increased airway collapsibility.
  
  
  METHODS
  We report 2 cases of boys with Down syndrome and a history of obstructive sleep apnea in whom adverse narrowing of the retroglossal airway is caused by continuous positive airway pressure applied via face mask as documented with magnetic resonance imaging.
  
  
  CONCLUSIONS
  Administration of continuous positive airway pressure by means of face mask to patients can result in adverse effects on the airway patency by pushing the tongue posteriorly. Awareness of this effect on patients with open mouths and large tongues, as present in Down syndrome, is important for sleep apnea treatment, anesthesia, and emergency respiratory support. Generalization of our observation is not possible at this time. Additional prospective studies of the effects of continuous positive airway pressure on airway patency in sedated and/or anesthetized children are required to confirm our anecdotal observations.
authors.affiliation: Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati,OH 45229, USA. robert.fleck@cchmc.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fleck
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahmoud
authors.forename: Keith
authors.initials: K
authors.lastname: McConnell
authors.forename: Sally R
authors.initials: SR
authors.lastname: Shott
authors.forename: Ephraim
authors.initials: E
authors.lastname: Gutmark
authors.forename: Raouf S
authors.initials: RS
authors.lastname: Amin
mesh_terms: D000402:Airway Obstruction / Q000209:etiology* / Q000503:physiopathology*; D002648:Child; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D004314:Down Syndrome / Q000503:physiopathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D017214:Laryngeal Masks; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*