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Djkowich M, Olmstead D, Castro-Codesal ML, Scott S. Who is using noninvasive ventilation? A descriptive study examining the population enrolled in a pediatric noninvasive ventilation program. J SPEC PEDIATR NURS 2021; 26:e12326. [PMID: 33493391 DOI: 10.1111/jspn.12326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022]
Abstract
DESIGN AND METHODS This study used a retrospective design and involved reviewing the charts of infants and children enrolled in the noninvasive ventilation (NIV) program at a quaternary pediatric hospital located in Western Canada in 2017. Demographic and clinical variables were collected, along with variables related to adherence to NIV therapy. For data storage and analysis purposes, a comprehensive database was created. Descriptive statistics were used to analyze and better understand patterns within the data. RESULTS Findings included a comprehensive description of the population of infants and children enrolled in this NIV program in 2017, including demographic and clinical variables as well as follow-up and adherence data. This study identified that the NIV program at this pediatric center has unique characteristics which provide an exciting opportunity for further research into the population that requires NIV support. PRACTICE IMPLICATIONS This study presents new knowledge, gathered by examining the clinical characteristics of a pediatric population that requires NIV, which can be used to inform practice, support NIV program planning, and health resource allocation, as well as suggest directions for future research on pediatric NIV therapy.
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Affiliation(s)
- Mikelle Djkowich
- Alberta Health Services, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Deborah Olmstead
- Alberta Health Services, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Shannon Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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2
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Kasi AS, Anand N, Harford KL, Landry AM, Alfonso KP, Taylor M, Keens TG, Leu RM. Tracheostomy decannulation to noninvasive positive pressure ventilation in congenital central hypoventilation syndrome. Sleep Breath 2021; 26:133-139. [PMID: 33852109 DOI: 10.1007/s11325-021-02368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/13/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Noninvasive positive pressure ventilation (NPPV) may permit tracheostomy decannulation (TD) in patients with congenital central hypoventilation syndrome (CCHS) requiring nocturnal positive pressure ventilation via tracheostomy (PPV-T). There is limited evidence on optimal strategies for transitioning patients from PPV-T to NPPV. This study aimed to describe the clinical course and outcome of children with CCHS who underwent TD and transitioned from PPV-T to NPPV. METHODS Retrospective review was conducted on patients with CCHS using nocturnal PPV-T who underwent TD to NPPV. The results of clinical evaluations, airway endoscopy, polysomnography, and clinical course leading to TD were analyzed. RESULTS We identified 3 patients with CCHS aged 8-17 years who required PPV-T only during sleep. Patients underwent systematic multidisciplinary evaluations with a pediatric psychologist, pulmonologist, sleep physician, and otolaryngologist utilizing a TD algorithm. These included evaluation in the sleep clinic, NPPV mask fitting and desensitization, endoscopic airway evaluation, daytime tracheostomy capping, acclimatization to low-pressure NPPV, polysomnography with capped tracheostomy and NPPV titration, and if successful, TD. All patients underwent successful TD following optimal titration of NPPV during polysomnography. The duration to TD from decision to pursue NPPV was between 2.4 and 10.6 months, and the duration of hospitalization for TD was between 4 and 5 days. There were no NPPV-related complications; however, all patients required surgical closure of tracheocutaneous fistula. CONCLUSION NPPV may be an effective and feasible option for patients with CCHS requiring PPV-T during sleep and permits TD. In patients with CCHS, a systematic multidisciplinary algorithm may optimize successful transition to NPPV and TD.
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Affiliation(s)
- Ajay S Kasi
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA.
| | - Neesha Anand
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA
| | - Kelli-Lee Harford
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA
| | - April M Landry
- Division of Pediatric Otorhinolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristan P Alfonso
- Division of Pediatric Otorhinolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Melissa Taylor
- Pediatric Sleep Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Thomas G Keens
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Roberta M Leu
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA
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Abstract
Improved recognition of obstructive sleep apnea (OSA) in children has led many to identify effective strategies to treat pediatric OSA. Positive airway pressure (PAP) therapy in children, which has been shown to resolve OSA, is highly contingent on adequate adherence. In pediatrics, adherence is complex, related largely to the influence of age. Consequently, reported adherence rates in children are often lower than adults. Notwithstanding, studies have identified significant risk factors, some modifiable, and several intervention strategies that may improve pediatric adherence. Close follow-up, including use of cloud-based monitoring, of children using PAP therapy may optimize adherence further.
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Affiliation(s)
- Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, University of California-San Diego, 9500 Gilman Drive MC 0731, San Diego, CA 92093-0731, USA; Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92120, USA.
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4
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Shi J, Al-Shamli N, Chiang J, Amin R. Management of Rare Causes of Pediatric Chronic Respiratory Failure. Sleep Med Clin 2020; 15:511-526. [PMID: 33131661 DOI: 10.1016/j.jsmc.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The need for long-term noninvasive positive pressure ventilation (NiPPV) in children with chronic respiratory failure is rapidly growing. This article reviews pediatric-specific considerations of NiPPV therapy. Indications for NiPPV therapy can be categorized by the cause of the respiratory failure: (1) upper airway obstruction, (2) musculoskeletal and/or neuromuscular disease, (3) lower respiratory tract diseases, and (4) control of breathing abnormalities. The role of NiPPV therapy in select rare conditions (spinal muscular atrophy, congenital central hypoventilation syndrome, cerebral palsy, scoliosis, and Chiari malformations) is also reviewed.
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Affiliation(s)
- Jenny Shi
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Nawal Al-Shamli
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Jackie Chiang
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada.
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5
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Diskin C, McVeigh TP, Cox DW. Sleep disordered breathing in children with Down syndrome in the Republic of Ireland. Am J Med Genet A 2020; 182:2847-2856. [PMID: 32902194 DOI: 10.1002/ajmg.a.61855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022]
Abstract
Down syndrome (DS) is associated with a complex respiratory phenotype, including obstructive sleep apnea syndrome (OSAS). The study explored parent-reported prevalence and presentation of OSAS symptoms in children and adolescents with DS in Ireland. It also investigated treatment and compliance in those who have OSAS. A cross-sectional survey was distributed to parents registered with Down Syndrome Ireland (DSI) (n = 1,343). Data was collated and analyzed using SPSS v23. The response rate was 393 (29%). Twenty-one percent of parents (n = 84) reported a diagnosis of OSAS in their child. The parents of children reported as compliant with continuous positive airway pressure (CPAP) were more likely to report a perceived benefit of treatment (p = .018). Ninety-two percent (n = 212) of children without a formal diagnosis of OSAS had at least one symptom (median 4 symptoms) of the condition. This, the largest survey of parental reporting of OSAS or its symptoms, demonstrates a high reported prevalence of symptoms in children and adolescents with DS in Ireland without a formal diagnosis of OSAS, indicating under-recognition. In treated patients, perception of the benefit of CPAP correlated with reported compliance, suggesting a need for tailored education.
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Affiliation(s)
- Catherine Diskin
- Department of Respiratory Medicine, Children's Hospital Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Des W Cox
- Department of Respiratory Medicine, Children's Hospital Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Amaddeo A, Khirani S, Griffon L, Teng T, Lanzeray A, Fauroux B. Non-invasive Ventilation and CPAP Failure in Children and Indications for Invasive Ventilation. Front Pediatr 2020; 8:544921. [PMID: 33194886 PMCID: PMC7649204 DOI: 10.3389/fped.2020.544921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
Non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) are effective treatments for children with severe sleep disordered breathing (SBD). However, some patients may present too severe SDB that do not respond to NIV/CPAP or insufficient compliance to treatment. A careful revaluation of the interface and of ventilator settings should be performed before considering alternative treatments. In patients with obstructive sleep apnea (OSA), alternatives to CPAP/NIV rely on the underlying disease. Ear-nose-throat (ENT) surgery such as adeno-tonsillectomy (AT), turbinectomy or supraglottoplasty represent an effective treatment in selected patients before starting CPAP/NIV and should be reconsidered in case of CPAP failure. Rapid maxillary expansion (RME) is restricted to children with OSA and a narrow palate who have little adenotonsillar tissue, or for those with residual OSA after AT. Weight loss is the first line therapy for obese children with OSA before starting CPAP and should remain a priority in the long-term. Selected patients may benefit from maxillo-facial surgery such as mandibular distraction osteogenesis (MDO) or from neurosurgery procedures like fronto-facial monobloc advancement. Nasopharyngeal airway (NPA) or high flow nasal cannula (HFNC) may constitute efficient alternatives to CPAP in selected patients. Hypoglossal nerve stimulation has been proposed in children with Down syndrome not tolerant to CPAP. Ultimately, tracheostomy represents the unique alternative in case of failure of all the above-mentioned treatments. All these treatments require a multidisciplinary approach with a personalized treatment tailored on the different diseases and sites of obstruction. In patients with neuromuscular, neurological or lung disorders, non-invasive management in case of NIV failure is more challenging. Diaphragmatic pacing has been proposed for some patients with central congenital hypoventilation syndrome (CCHS) or neurological disorders, however its experience in children is limited. Finally, invasive ventilation via tracheotomy represents again the ultimate alternative for children with severe disease and little or no ventilatory autonomy. However, ethical considerations weighting the efficacy against the burden of this treatment should be discussed before choosing this last option.
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Affiliation(s)
- Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Université de Paris, VIFASOM, Paris, France.,ASV Sante, Gennevilliers, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Theo Teng
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Agathe Lanzeray
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
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Rybczynski S, Flanders XC, Murphy C, Hughes D, Reber P. Case Report: Ventilator weaning, tracheostomy decannulation and noninvasive ventilation in an adolescent with autism spectrum disorder and new onset spinal cord injury. Spinal Cord Ser Cases 2019; 5:102. [PMID: 31871767 PMCID: PMC6911082 DOI: 10.1038/s41394-019-0248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction Spinal cord injury (SCI) is a cause of significant psychosocial stress not only to the individual with SCI but also to their family. This is compounded when an individual with a new SCI has premorbid behavioral and medical conditions. For individuals requiring long term positive pressure ventilation, transition to noninvasive ventilation (NIV) can improve the long term outcome and improve quality of life. Case presentation This case report describes a teenage boy with premorbid autism spectrum disorder who incurred an acute SCI and developed chronic respiratory failure. He was admitted to acute inpatient rehabilitation with tracheostomy and ventilator dependence. Using an interdisciplinary team approach with in vivo desensitization behavioral interventions, he was successfully weaned off mechanical ventilation, his tracheostomy tube was removed, and he was transitioned to NIV. Discussion This case describes a medically complex adolescent who was successfully transitioned to NIV through behavioral desensitization using a team approach. This is noteworthy given the magnitude of behaviors demonstrated prior to his desensitization protocol. This case demonstrates how serious behavioral barriers to NIV can be overcome using desensitization and strategic behavioral reinforcement techniques.
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Affiliation(s)
- Suzanne Rybczynski
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, Baltimore, MD USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Ximena Celedon Flanders
- Department of Pediatric Psychology, Kennedy Krieger Institute, Baltimore, MD USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Camara Murphy
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
- Pediatric Psychology Program, Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD USA
| | - Dustin Hughes
- Department of Respiratory Therapy, Kennedy Krieger Institute, Baltimore, MD USA
| | - Paula Reber
- Department of Nursing, Kennedy Krieger Institute, Baltimore, MD USA
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8
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Parmar A, Baker A, Narang I. Positive airway pressure in pediatric obstructive sleep apnea. Paediatr Respir Rev 2019; 31:43-51. [PMID: 31130426 DOI: 10.1016/j.prrv.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by snoring, recurrent obstruction (apneas) of the upper airway which disrupts normal ventilation during sleep. In the last decade, there has been a increase in children diagnosed with persistent, severe OSA attributed to (1) the obesity epidemic as 25-60% of obese children will have obesity related OSA (2) advances in medical technology that have increased life expectancy of medically complex children (3) improved diagnostics and (4) increased awareness. Positive airway pressure (PAP) is commonly used to treat persistent, severe OSA. PAP devices deliver pressurized air via nasal or oronasal interfaces to distend the upper airway and ameliorate OSA. Although effective in treating OSA, PAP adherence is suboptimal. This review article provides an overview of (1) PAP use in pediatric OSA (2) PAP devices (3) PAP adherence, (4) strategies and interventions to improve adherence and (5) Optimizing PAP delivery during pediatric to adult transition.
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Affiliation(s)
- Arpita Parmar
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Adele Baker
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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9
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Mendoza-Ruiz A, Dylgjeri S, Bour F, Damagnez F, Leroux K, Khirani S. Evaluation of the efficacy of a dedicated table to improve CPAP adherence in children: a pilot study. Sleep Med 2018; 53:60-64. [PMID: 30447400 DOI: 10.1016/j.sleep.2018.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Only a few studies have addressed strategies to improve continuous positive airway pressure (CPAP) adherence in children with obstructive sleep apnea. The aim of our study was to assess the efficacy of a table based on token economy to improve CPAP adherence. METHODS A table was proposed to children nonadherent to CPAP (<3 h per night of CPAP use), eight days after CPAP initiation (D8). The child has to fill the table on a daily basis with green (I used my CPAP this night) or red (I did not use my CPAP) tokens. Objectives of CPAP use and rewards were decided between the child and their parents. An assessment of CPAP adherence was performed one month after initiation of table filling (M1) and compared to CPAP adherence at D8, and to data of adherent children. RESULTS Data of six nonadherent and nine adherent children were gathered (age 5 ± 5 vs. 5 ± 3 years, p = 0.953; apnea-hypopnea index 20 ± 15 vs. 25 ± 16 events/h, p = 0.550, respectively). Mean CPAP adherence at D8 was 4.7 ± 1.6 nights/wk and 1h00 ± 0h33 in the nonadherent children, vs. 6.9 ± 0.4 nights/wk and 7h16 ± 1h51 in the adherent group (p < 0.01). The mean number of nights per week at M1 was 6.4 ± 0.6 nights in nonadherent children (p = 0.086), and was equivalent to that in adherent children (6.8 ± 0.6 nights, p = 0.126). Mean adherence at M1 increased to 4h31 ± 1h12 in non-adherent children (p < 0.001), but was still lower when compared to that in adherent children (7h27 ± 2h00, p = 0.007). CONCLUSION The study findings imply that use of a simple table by a child appears to be effective in improving CPAP adherence at one month.
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Affiliation(s)
- Alexis Mendoza-Ruiz
- ASV Santé, Gennevilliers, France; Department of Neurosensory Function Tests, Hôpital de Gonesse, Gonesse, France.
| | - Suela Dylgjeri
- Department of Neurosensory Function Tests, Hôpital de Gonesse, Gonesse, France
| | - Florence Bour
- Department of Neurosensory Function Tests, Hôpital de Gonesse, Gonesse, France
| | | | | | - Sonia Khirani
- ASV Santé, Gennevilliers, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Amaddeo A, Frapin A, Touil S, Khirani S, Griffon L, Fauroux B. Outpatient initiation of long-term continuous positive airway pressure in children. Pediatr Pulmonol 2018; 53:1422-1428. [PMID: 30070059 DOI: 10.1002/ppul.24138] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Current guidelines recommend initiating continuous positive airway pressure (CPAP) in children during an overnight in-hospital titration study. Due to a shortage of hospital beds and economic constraints, we started a program for outpatient initiation of CPAP in selected children with obstructive sleep apnea (OSA). METHODS Objective CPAP compliance and efficacy were evaluated in consecutive children enrolled in an outpatient CPAP program when they fulfilled the following criteria: persistent OSA, age >6 months, stable condition, family living in the Parisian area and agreeing with a regular follow-up. RESULTS Thirty-one children, median (range) age 8.9 years (0.8-17.5), were included in the program. The most common diagnosis were Down syndrome (n = 7), achondroplasia (n = 3), and obesity (n = 3). Median baseline obstructive apnea-hypopnea index (OAHI) was 12.5 events/h (5-100). Median duration of follow-up was 12.3 months (2.2-25.2). Four subjects (three adolescents with Down syndrome) were not compliant at 2-month follow-up with a compliance <4 h/night. In the other 27 subjects, median compliance was 08:21 h:min/night (05:45-12:20), with a median number of night use per month of 25 (18-30). CPAP efficacy at the end of follow-up was excellent in the compliant subjects with a median AHI of two events/h (0-4) and normal gas exchange with CPAP therapy. Three subjects were successfully weaned from CPAP treatment during the study period. CONCLUSION Initiating CPAP in an outpatient setting in children is feasible and effective in selected subjects. A high rate of compliance can be achieved as well as a correction of OSA.
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Affiliation(s)
- Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Paris Descartes University, Paris, France.,INSERM U 955, Team 13, Créteil, France
| | - Annick Frapin
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Samira Touil
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,ASV Santé, Gennevilliers, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Paris Descartes University, Paris, France.,INSERM U 955, Team 13, Créteil, France
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11
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12
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McGinley B. Non-Invasive Mechanical Ventilation in Children: An Overview. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Harford KL, Jambhekar S, Com G, Pruss K, Kabour M, Jones K, Ward WL. Behaviorally based adherence program for pediatric patients treated with positive airway pressure. Clin Child Psychol Psychiatry 2013; 18:151-63. [PMID: 23028201 DOI: 10.1177/1359104511431662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Positive Airway Pressure (PAP) devices are being increasingly used in pediatric populations for problems including Obstructive Sleep Apnea. There is limited literature regarding pediatric adherence with PAP treatment or successful interventions that improve adherence. This paper describes a clinical program for pediatric PAP users which was designed to improve adherence of patients prescribed PAP therapy and involves intensive assessment and behavioral intervention. METHOD The design and implementation of the program is described, including the purpose, goals, programmatic structure, clinical content, type and training of personnel, strengths and limitations and financial concerns as well as the challenges with the development and application of the program's protocol. RESULTS Preliminary outcome data show short-term improvements in consistent usage for many of the patients. CONCLUSIONS The program shows some promise and provides a framework for future program development and research.
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Affiliation(s)
- Kelli-Lee Harford
- University of Wisconsin Hospital and Clinics, 1675 Highland Avenue, Madison, WI 53792, USA.
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Luersen K, Davis SA, Kaplan SG, Abel TD, Winchester WW, Feldman SR. Sticker charts: a method for improving adherence to treatment of chronic diseases in children. Pediatr Dermatol 2012; 29:403-8. [PMID: 22471987 DOI: 10.1111/j.1525-1470.2012.01741.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words "positive reinforcement OR behavior therapy" and "adherence OR patient compliance" and "child." Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes.
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Affiliation(s)
- Kara Luersen
- Departments of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157, USA
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16
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Tratamiento con presión positiva continua en los trastornos respiratorios del sueño en los niños. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61 Suppl 1:74-9. [DOI: 10.1016/s0001-6519(10)71250-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Berry RB. Noninvasive Positive Pressure Ventilation Titration and Treatment Initiation for Chronic Hypoventilation Syndromes. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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Chediak AD. Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2009.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meltzer LJ, Phillips C, Mindell JA. Clinical psychology training in sleep and sleep disorders. J Clin Psychol 2009; 65:305-18. [PMID: 19132641 DOI: 10.1002/jclp.20545] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is growing evidence to suggest that clinical psychologists would benefit from more training in sleep and sleep disorders. Sleep disturbances are commonly comorbid with mental health disorders and this relationship is often bidirectional. In addition, psychologists have become integral members of multidisciplinary sleep medicine teams and there are not enough qualified psychologists to meet the clinical demand. The purpose of this study was to evaluate the current education on sleep and sleep disorders provided to clinical psychology predoctoral students and interns. Directors of graduate programs and internships (N=212) completed a brief online survey on sleep education in their program. Only 6% of programs offers formal didactic courses in sleep, with 31% of programs offering training in the treatment of sleep disorders. There are few programs with sleep faculty (16%), and most reported that their institutions were ineffective in providing sleep education. Thirty-nine percent of training directors reported they would implement a standard curriculum on sleep, if available. The findings from this study suggest that more opportunities are needed for trainees in clinical psychology to gain didactic and clinical experience with sleep and sleep disorders.
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Affiliation(s)
- Lisa J Meltzer
- The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
The purpose of this study was to describe the function and structure of an interdisciplinary outpatient pediatric sleep clinic. In addition, the frequency of individual and comorbid sleep diagnoses, the prevalence of comorbid medical or psychiatric disorders, and the types of treatment recommendations and referrals provided to patients at the end of their clinic visits was examined. Over a 4-month period, 265 consecutive patients were evaluated in the sleep clinic by trainees, nurses, and attendings in pulmonary medicine, neurology, and psychology. Obstructive sleep apnea was the most common diagnosis, followed by behavioral insomnia of childhood. Over half of the patients had a comorbid medical diagnosis, and 31% had a comorbid psychiatric diagnosis. Polysomnography was the most common recommendation, with 38% of patients receiving at least one behavioral recommendation. The results of this descriptive study support the need for an interdisciplinary approach to pediatric sleep medicine, providing broad training to trainees of all disciplines while improving the clinical care for children with sleep problems.
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Affiliation(s)
- Lisa J Meltzer
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Abstract
UNLABELLED PURPOSE FOR REVIEW: Childhood sleep-disordered breathing (SDB) is associated with a myriad of health problems that underscore the need for early diagnosis and treatment. Children with SDB present with behavior problems, deficits of general intelligence, learning and memory deficits, evidence of brain neuronal injury, increased cardiovascular risk, and poor quality of life. Children are in a rapid state of cognitive development; therefore, alterations of health and brain function associated with SDB could permanently alter a child's social and economic potential, especially if the disorder is not recognized early in life or is treated inadequately. RECENT FINDINGS There is evidence that the majority of the problems associated with SDB improve with treatment. Treatment strategies are now being aimed at mechanisms underlying the disorder. There are multiple treatment options available to children; some are novel, with pending treatments on the horizon that may replace age-old therapies such as adenotonsillectomy or nasal positive pressure. SUMMARY It is imperative that healthcare workers actively seek out signs and symptoms of SDB in patients to improve early detection and treatment for prevention of long-term morbidity.
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Current World Literature. Curr Opin Pulm Med 2008; 14:600-2. [DOI: 10.1097/mcp.0b013e328316ea6b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2008; 5:274-82. [PMID: 18250221 PMCID: PMC2645258 DOI: 10.1513/pats.200708-138mg] [Citation(s) in RCA: 258] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Accepted: 10/18/2007] [Indexed: 11/20/2022]
Abstract
Obstructive sleep apnea (OSA) in children has emerged not only as a relatively prevalent condition but also as a disease that imposes a large array of morbidities, some of which may have long-term implications, well into adulthood. The major consequences of pediatric OSA involve neurobehavioral, cardiovascular, and endocrine and metabolic systems. The underlying pathophysiological mechanisms of OSA-induced end-organ injury are now being unraveled, and clearly involve oxidative and inflammatory pathways. However, the roles of individual susceptibility (as dictated by single-nucleotide polymorphisms), and of environmental and lifestyle conditions (such as diet, physical, and intellectual activity), may account for a substantial component of the variance in phenotype. Moreover, the clinical prototypic pediatric patient of the early 1990s has been insidiously replaced by a different phenotypic presentation that strikingly resembles that of adults afflicted by the disease. As such, analogous to diabetes, the terms type I and type II pediatric OSA have been proposed. The different manifestations of these two entities and their clinical course and approaches to management are reviewed.
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