title: Polygraphic respiratory events during sleep in children treated with home continuous positive airway pressure: description and clinical consequences.
abstract: OBJECTIVE
  Data are scarce on respiratory events during sleep for children treated at home with continuous positive airway pressure (CPAP). The present study aimed to characterize the respiratory events with CPAP during sleep and to analyze their clinical consequences.
  
  
  METHODS
  Consecutive polygraphies (PG) performed on stable children treated with CPAP were analyzed and scored using SomnoNIV Group definitions. For every respiratory event, the presence of a 3% oxygen desaturation and/or an autonomic arousal was systematically searched. Nocturnal gas exchange was assessed using summary data of oximetry and transcutaneous carbon dioxide pressure recordings.
  
  
  RESULTS
  Twenty-nine consecutive polygraphies, performed on 26 children (mean age 7.8 ± 6.2 years, mean CPAP use 10.6 ± 14.4 months), were analyzed. The index of total respiratory events was low (median value 1.4/h, range 0-34). The mean number of different types of respiratory events per PG was 2 ± 1 (range 0-4), with always a predominant event. Partial or total upper airway obstruction without a decrease in ventilatory drive was the most frequent event and was the most frequently associated with an oxygen desaturation (in 30% of the events) and an autonomic arousal (in 55% of the events). Weak correlations were observed between nocturnal oximetry and PG results.
  
  
  CONCLUSIONS
  The index of respiratory events during CPAP treatment for stable children is low. As these events may be associated with an oxygen desaturation or an autonomic arousal, and as nocturnal gas exchange cannot predict PG results, a systematic sleep study seems justified for the routine follow-up of children treated with CPAP.
authors.affiliation: AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Pediatric Department, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Amaddeo
authors.affiliation: Department of Paediatrics, Azienda Ospedaliera Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Caldarelli
authors.affiliation: AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.
authors.forename: Marta
authors.initials: M
authors.lastname: Fernandez-Bolanos
authors.affiliation: AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Physiological Department, University of Montpellier I, Montpellier, France; INSERM U1046, University of Montpellier I, Montpellier, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Moreau
authors.affiliation: AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; ADEP ASSISTANCE, Suresnes, France.
authors.forename: Adriana
authors.initials: A
authors.lastname: Ramirez
authors.affiliation: AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; ASV Santé, Gennevilliers, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Khirani
authors.affiliation: AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, Paris, France; INSERM U 955, Equipe 13, Créteil, France. Electronic address: brigitte.fauroux@nck.aphp.fr.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Fauroux
mesh_terms: D000293:Adolescent; D000403:Airway Resistance / Q000502:physiology; D001143:Arousal / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010092:Oximetry; D017286:Polysomnography; D011659:Pulmonary Gas Exchange / Q000502:physiology; D015656:Respiratory Mechanics / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy
keywords: Arousal; Child; Continuous positive airway pressure (CPAP); Desaturation; Polygraphy; Sleep