Many Kids Don't Adhere to Sleep Apnea Therapy

[varkam]

Forbes.com
March 24, 2006
Article

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FRIDAY, March 24 (HealthDay News) -- Children with troublesome sleep apnea don't always use the "gold standard" therapy -- a pressurized nighttime air mask -- consistently enough to provide them with maximum benefit, a new study suggests.

The therapy, called positive airway pressure (PAP), involves having the sleeping patient wear a breathing mask that delivers a gentle, steady flow of air, which significantly improves breathing and oxygen levels when used regularly. The therapy improves the quality of sleep and daytime alertness.

<snip>

The follow-up sleep study showed that the children's sleep apnea went from severe to mild or better. However, 78 percent of the parents revealed that their children did not use the PAP device every night. Even the children who did use the device every night did so for an average of only five hours a night. This is insufficient, given children's long sleep hours, the researchers said.

They also found that parents tended to overestimate children's use of the PAP device by about two hours.


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[roguevalley]

1. my mom uses one. bit of a fussy thing but life saving.

[BigBearJohn]

2. Well, it's hard enough for an adult to get used to; I feel sorry for a kid

It's not easy sleeping with constant air being pumped down your
throat. It took months and months for me to get used to my CPAP

[undergroundpanther]

3. I just got diagnosed with apnea

and it sux. it just sux.I hope I can deal with the masks and all.

[BigBearJohn]

6. Nobody had a more difficult time than I did. Thank God the machines

have improved. If you can, get a C-Flex machine.
It lets up on the pressure when you try to exhale.

[pnwmom]

4. I'm curious why the mask is the "gold standard." My three year old had

obstructive sleep apnea which resolved completely after her swollen tonsils and adenoids were removed. Same thing happened to her cousin, at about the same age.

[varkam]

5. Why CPAP is the gold standard in OSA treatment

I think it's a bit of a misnomer to say that CPAP is the gold standard for OSA treatment in kids. For a lot of kids, what is more preferred is the removal of tonsils or the adenoids or both - as if a kid has OSA, that's most likely the cause. Although I have seen some kids who've had those done and still have OSA, then CPAP is usually considered (although in at least one instance they did a trach on the poor kiddo).

But for adults, CPAP *is* the gold standard. The results for surgical intervention for the treatment of OSA are mixed at best, at least from what I've seen. I even went to a presentation by one of the more prominent ENTs around here, and I wasn't impressed by his data set. He said he'd cured more that 75% of his patients. But his definition of cure was a reduction of 50% in the AHI (apnea-hypopnea index, which is an average of the number of obstructions of the airway over total sleep time). So someone could stop breathing 100 times an hour, but if post-op they were at 40, they were "cured". Problem is, severe obstructive sleep apnea is termed as an AHI of 30 or greater. That's typically the result I see. However, with CPAP, it's possible to get virtually *everyone* with OSA to an AHI of 5 or under, which is in the normal range. Of course, the only drawback is that you actually have to wear the damn thing to be treated which some people cannot tolerate.

[pnwmom]

7. Thank you. We saw such a dramatic, and thus far permanent (she's

23) cure in our daughter, that I hated to think other parents might be discouraged from the surgery, if necessary.

On the other hand, you can add my husband to the list of CPAP successes. He started a few years ago, after I sent him in for evaluation for the second time (a few years earlier, a doctor had asked him who was bothered by his snoring. When told that I was the one who thought there was a problem, the doctor -- who had never met me -- told him not to worry about it then). Anyway, although my husband had thought he had no symptoms, after one week with the machine he was used to it. And when it broke down one night and had to be returned for another, he admitted that he had missed sleeping with it.