An Adverse Effect of Positive Airway Pressure on the Upper Airway Documented With Magnetic Resonance Imaging.
ABSTRACT IMPORTANCE Positive pressure air is used during basic life support to provide respirations and applied as continuous positive airway pressure to maintain a patent airway during sleep or anesthesia. These functions are more critical in children with obstructive sleep apnea, who often have smaller airway dimensions and increased airway collapsibility. OBSERVATIONS We report 2 cases of boys with Down syndrome and a history of obstructive sleep apnea in whom adverse narrowing of the retroglossal airway is caused by continuous positive airway pressure applied via face mask as documented with magnetic resonance imaging. CONCLUSIONS AND RELEVANCE Administration of continuous positive airway pressure by means of face mask to patients can result in adverse effects on the airway patency by pushing the tongue posteriorly. Awareness of this effect on patients with open mouths and large tongues, as present in Down syndrome, is important for sleep apnea treatment, anesthesia, and emergency respiratory support. Generalization of our observation is not possible at this time. Additional prospective studies of the effects of continuous positive airway pressure on airway patency in sedated and/or anesthetized children are required to confirm our anecdotal observations.
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ABSTRACT: The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner.Acta Otorrinolaringológica Española 08/2014;
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ABSTRACT: Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 11/2014; 40(6):658-668. DOI:10.1590/S1806-37132014000600010