Long-term benefits in sleep, breathing and growth and changes in adherence and complications in children using noninvasive ventilation

Abstract

RATIONALE: Long-term noninvasive ventilation (NIV) is a standard therapy for children with impaired sleep breathing and chronic respiratory insufficiency. Evidence of longitudinal benefits, however, is lacking. OBJECTIVES: The aim of this study is to determine the long-term NIV efficacy, its impact on growth and changes in adherence and complication rates over time. METHODS: This multicenter retrospective longitudinal cohort study examines children started on long-term NIV, both continuous and bi-level positive airway pressure, over a 10-year period. Data were collected at NIV initiation, initial follow-up and most recent visit including: 1) polysomnography parameters; 2) body mass index (BMI); 3) adherence; and 4) NIV-related complications. Mixed effects models were used for longitudinal analysis. MEASUREMENTS AND MAIN RESULTS: Sufficient data were available for 429 children. Sleep parameters, apnea-hypopnea index and gas exchange improved after NIV initiation with sustained benefits over time. Changes in BMI differed by BMI at NIV initiation; z-score in normal-weight children increased by 0.11 per year of therapy, 0.44 per year in underweight children with no change for overweight children and a drop of 0.15 per year in obese children. The number of complications remained low and unchanged (1.32, 95%CI 1.00–1.68) while adherence improved by 4% in percentage of days with use >4 hours per month and 19 extra minutes per night for each year of therapy. CONCLUSIONS: Long-term NIV is efficacious in correcting sleep and breathing parameters and demonstrated benefits in growth for underweight and obese children. Improvement in adherence and complication rates over time suggests the burden of NIV use decreases over time.