Abstract
Treatment options may be limited for infants with obstructive sleep apnea when there is no surgically correctable upper airway lesion. We therefore evaluated, retrospectively, the efficacy of low-flow oxygen as a therapeutic option for infant obstructive sleep apnea. We reviewed the medical charts of 23 infants who had undergone a therapeutic trial of low-flow oxygen during polysomnography. Split-night polysomnography was used in 21/23 subjects while 2/23 had undergone two separate, full-night polysomnography sleep architecture and respiratory findings on the baseline polysomnogram segment that was obtained in room air were compared with the segment on low-flow oxygen (0.25–1 L/min). Wilcoxon signed rank or McNemar’s test were used as indicated for comparing apnea hypopnea index and measures of sleep architecture at baseline and with oxygen therapy. The mean (±SD) age of subjects was 4.8 (±2.7) months, with 52% being males. The median apnea hypopnea index fell from a baseline of 18 (range 7–43) to 3 (range 1–19; p = 0.001) on oxygen. The baseline median obstructive/mixed apnea index decreased from 2 (range 1–16) to 1 during oxygen therapy (range 0–1; p = 0.003). Additionally, a significant decrease in central apnea index (median interquartile range (IQR) 1 (0–2) vs. 0 (0–1), p = 0.002) was noted. Sleep efficiency remained unaffected, while O2 saturation (SaO2) average and SaO2 nadir improved on oxygen. We were able to confirm the utility of low-flow oxygen in reducing central, obstructive, and mixed apneas and improving average oxygen saturation in infants with obstructive sleep apnea (OSA).
Highlights
Obstructive sleep apnea (OSA) seen during infancy is often related to gastro-esophageal reflux, laryngotracheomalacia, craniofacial anomalies, or neuromuscular disorders [1,2]
Given the paucity of evidence supporting the efficacy of oxygen in treating infant OSA, we report on our experience in this regard, with an emphasis on changes in sleep-related respiratory variables
The findings of the current study suggest that use of low-flow supplemental oxygen in infants with OSA may decrease obstructive and mixed apneas and hypopneas
Summary
Obstructive sleep apnea (OSA) seen during infancy is often related to gastro-esophageal reflux, laryngotracheomalacia, craniofacial anomalies, or neuromuscular disorders [1,2]. Significant adenotonsillar hypertrophy, a common etiology in older children, is encountered less often, adenotonsillectomy is generally a less frequent treatment option. Even when adenotonsillectomy is performed for relief of obstructive sleep apnea in infancy, it seems to benefit more those patients who lack comorbidities [3]. Positive airway pressure (PAP) is utilized in older children and adults, but these devices are not approved by the Food and Drug Administration for use in those weighing less than 13 kg. Oxygen therapy is used empirically to treat OSA in this age group.
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