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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Efficacy of Automated Continuous Positive Airway Pressure in Children With Sleep-Related Breathing Disorders in an Attended Setting
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Efficacy of Automated Continuous Positive Airway Pressure in Children With Sleep-Related Breathing Disorders in an Attended Setting

机译：在出席环境中睡眠相关呼吸障碍儿童自动持续正气道压力的功效

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Introduction . The purpose of this study was to evaluate the safety and efficacy of automated continuous positive airway pressure (Auto-CPAP) in children.Sleep-related breathing disorders (SRBDs) include the clinical spectrum of symptomatic chronic snoring, upper airway resistance syndrome, and obstructive sleep apnea. This spectrum occurs in adults and children. Less data are available for children despite recognition of the condition’s prevalence. CPAP has been an established treatment for adults and children. Treatment with Auto-CPAP has been available for adults but has not been reported previously in children.Methods . A group of 14 children (8 months to 12 years old) was evaluated prospectively with baseline polysomnographic study and CPAP titration performed with Auto-CPAP under sleep technologist supervision.Results .The results demonstrated that Auto-CPAP is sensitive and effective for children with obstructive sleep apnea in an attended setting. There was 1 subject who did not seem to tolerate Auto-CPAP, but when she was switched to conventional CPAP, she did not tolerate that either. In this subject, the mask never fit well. She was excluded from the analysis. All other patients had a decrease in the number of abnormal breathing events during sleep. The respiratory disturbance index decreased from a mean of 12.6 (SD: 12.4) to 2.6 (SD: 2.7) events per hour. The lowest oxygen saturation improved from a mean of 86% (SD: 10.8) to 93.6% (SD: 3.9).Conclusions . We conclude that Auto-CPAP is safe and effective in an attended environment. Auto-CPAP did not eliminate all the abnormal respiratory events. In subjects 1 and 14, the final respiratory index improved but remained 5 events per hour (5.9 and 7.7, respectively). We suspect that this was because of problems with the masks leaking, which illustrates the importance of follow-up and possible need for retitration in some patients. Proper mask fit is essential for successful treatment. Additional work is needed to evaluate its utility in the home setting. This study was designed to evaluate Auto-CPAP titration in an attended environment. It did not indicate information about the effectiveness in an unattended or home setting. We demonstrate that Auto-CPAP is able to detect abnormal breathing events during sleep in children and may provide the necessary pressure to correct these events. Auto-CPAP can be used safely for pressure titration in an attended setting. Auto-CPAP devices from different manufactures are commercially available for adults. These different devices may have different algorithms and sensitivities to detect abnormal breathing episodes. This study was performed with only 1 specific model of Auto-CPAP. Our results should not be extrapolated to other Auto-CPAP devices without empirical confirmation of the devices’ ability to detect and correct events in children. Auto-CPAP can be an alternative treatment for SRBDS in the pediatric population. These results allow for speculation of possible applications for Auto-CPAP in children. A potential advantage of Auto-CPAP includes permitting the initiation of treatment while awaiting a standard CPAP titration. The variable pressure response of Auto-CPAP allows for treatment under different situations such as upper airway infections, different sleeping positions, and changes in weight. As the child grows, the amount of positive pressure needed to maintain airway patency may change. Auto-CPAP may be able to adjust to these changing pressure requirements. Auto-CPAP does not eliminate the need for periodic office visits and evaluations of the clinical course.
机译：介绍 。本研究的目的是评估自动连续正气道压力（自动CPAP）在儿童中的安全性和有效性。有效的呼吸紊乱（SRBD）包括症状慢性打鼾，上气道阻力综合征和阻塞性的临床谱睡眠呼吸暂停。该频谱发生在成人和儿童中。尽管识别条件的普遍存在，但儿童可以获得更少的数据。 CPAP一直是成人和儿童的既定待遇。患有自动CPAP的治疗已经适用于成人，但尚未在儿童中报告。方法。一群14名儿童（8个月至12岁）是前瞻性的，并在睡眠专家监督下，通过自动CPAP进行了基线多面纲研究和CPAP滴定。结果表明，自动CPAP对妨碍障碍物的儿童敏感而有效。睡眠呼吸暂停在出席的环境中。有1个受试者似乎没有忍受自动CPAP，但是当她被切换到传统的CPAP时，她也没有容忍。在这个主题中，面具永远不会很好。她被排除在分析之外。所有其他患者睡眠期间的异常呼吸事件数量减少。呼吸道障碍指数从平均值降低为每小时12.6（SD：12.4）至2.6（SD：2.7）事件。从平均值为86％（SD：10.8）至93.6％（SD：3.9）的最低氧饱和度.Conclusions。我们得出结论，自动CPAP在出席环境中是安全和有效的。自动CPAP没有消除所有异常呼吸事件。在主题1和14中，最终呼吸指数得到改善但仍然存在>每小时5个事件（分别为5.9和7.7）。我们怀疑这是因为泄漏的面具问题，这表明了一些患者在某些患者中进行后续行动和可能需要的重要性。适当的面膜适合对于成功的治疗至关重要。需要额外的工作来评估其在家庭环境中的实用程序。本研究旨在评估出席环境中的自动CPAP滴定。它没有表示有关无人值守或家庭环境中有效性的信息。我们展示了自动CPAP能够在睡眠期间检测异常呼吸事件，并且可以提供必要的压力来纠正这些事件。自动CPAP可以安全地用于参加设置中的压力滴定。来自不同制造商的自动CPAP设备可用于成人。这些不同的设备可以具有不同的算法和敏感性来检测异常呼吸事件。该研究仅具有1个特定的自动CPAP模型进行。我们的结果不应推断到其他自动CPAP设备，而无需实证确认设备检测和纠正儿童事件的能力。自动CPAP可以是儿科人群中SRBD的替代处理。这些结果允许对儿童的自动CPAP进行猜测。自动CPAP的潜在优势包括允许在等待标准CPAP滴定的同时启动治疗。自动CPAP的可变压力响应允许在不同情况下进行处理，例如上气道感染，不同的睡眠位置和重量变化。随着孩子的增长，维持气道通畅所需的正压量可能会发生变化。自动CPAP可能能够适应这些变化的压力要求。自动CPAP不会消除对临床课程的定期办公室访问和评估的必要性。

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