title: Non-invasive ventilation in complex obstructive sleep apnea--a 15-year experience of a pediatric tertiary center.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) affects approximately 1-3% of pediatric population and is associated with significant morbidity. As adenotonsillar hypertrophy (ATH) is its primary cause in children, elective adenotonsillectomy is the first treatment of choice. Noninvasive ventilation (NIV) has been increasingly considered as an option, mainly for children with complex diseases, ineligible or waiting for surgeries, or after surgery failure.
  
  
  OBJECTIVE
  To describe the experience in the management of children with complex OSA, and to evidence the feasibility and advantages of NIV.
  
  
  METHODS
  This was a retrospective cohort study of 68 children on NIV, in whom complex OSA was the main indication for ventilation, in a Pediatric Respiratory Unit at a University Hospital between January 1997 and March 2012. Demographic and clinical data were collected on the underlying diagnosis, therapeutic interventions prior to NIV, NIV related issues and outcome.
  
  
  RESULTS
  Forty (59%) children were male, median age at starting NIV was 6 years and 7 months, with interquartile range (IQR) of 15-171 months. Twenty-two (32%) were infants and 25 (37%) adolescents. The most common diagnosis was congenital malformations and genetic disorders in 34 (50%) patients. Nine patients had cerebral palsy, 8 were post treatment for central nervous system tumors and 6 had inborn errors of metabolism. Three children had ATH and three obesity. The majority of patients (76%) had exclusively obstructive OSA and started CPAP. Ten patients had minor complications. Twenty-two patients stopped NIV due to clinical improvement, 8 were non-compliant and 8 patients died. NIV median duration was 21.5 months (IQR: 7-72).
  
  
  CONCLUSIONS
  NIV is feasible and well tolerated by children with OSA associated with complex disorders, and has been shown to have few complications even in infants and toddlers.
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal. Electronic address: inescarmogirbal@gmail.com.
authors: I C
authors: IC
authors: Girbal
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal.
authors: C
authors: C
authors: Gonçalves
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal.
authors: T
authors: T
authors: Nunes
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal.
authors: R
authors: R
authors: Ferreira
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal.
authors: L
authors: L
authors: Pereira
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal.
authors: A
authors: A
authors: Saianda
authors: Respiratory, Sleep and Ventilation Unit, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal.
authors: T
authors: T
authors: Bandeira
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D063087:Noninvasive Ventilation; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Apneia obstrutiva do sono; Children; Crianças; Noninvasive ventilation; Obstructive sleep apnea; Ventilação não invasiva