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Obstructive Sleep Apnea in Infants and Its Management With Nasal Continuous Positive Airway Pressure^*

^* From the David Read Laboratory, Department of Medicine, University of Sydney, NSW Australia.

Correspondence to: Frances McNamara, PhD, David Read Laboratory, Department of Medicine (D06), University of Sydney, 2006 Australia; e-mail: fam{at}med.usyd.edu.au

Study objectives: Nasal continuous positive airway pressure (nCPAP) is the most common treatment for obstructive sleep apnea (OSA) in adults, and it has been effective in the treatment of OSA in children. We wanted to determine the effectiveness of long-term nCPAP therapy for OSA in infants.

Patients: Twenty-four infants who had OSA were treated with nCPAP via nose mask. These infants had clinical histories that included a family history of sudden infant death syndrome, an apparent life-threatening event, or facial and upper airway anatomic abnormalities.

Interventions: Overnight polysomnographic studies were performed to assess the severity of OSA in each infant and to determine the appropriate level of continuous positive airway pressure (CPAP). Studies were repeated to determine the progress of OSA and the continuing need for CPAP in each infant.

Results: nCPAP pressures between 4 and 6 cm H₂O prevented obstruction and reversed sleep disturbances that were associated with OSA. Eighteen of the infants continued treatment at home from 1 month to > 4 years. CPAP therapy was discontinued in 13 infants after their OSA resolved. Five infants who have upper airway anatomic abnormalities remain on CPAP, and the pressure level required to prevent obstructive events during sleep has needed to be increased to as high as 10 cm H₂O.

Conclusions: nCPAP is an effective therapy for the management of OSA in infants, and it can be used effectively in the home environment. Regular follow-up is necessary, because the requirements for CPAP and pressure levels change with the infant's growth and development.

Key Words: infantile apnea • nasal continuous positive airway pressure • obstructive sleep apnea • sleep fragmentation

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