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PAP therapy improves neurobehavioral outcomes in children with OSA

Treatment of childhood obstructive sleep apnea syndrome (OSAS) with positive airway pressure (PAP) therapy improves a number of important neurobehavioral outcomes, according to a new study from the The Children's Hospital of Philadelphia.

"In our study of 52 children and adolescents with OSAS, we observed significant improvements in neurobehavioral function after three months of PAP therapy," said lead author Carole L. Marcus, professor of pediatrics at the Children's Hospital of Philadelphia. "These improvements were seen despite suboptimal adherence with treatment and were observed in a heterogeneous group of children, many with underlying medical conditions and/or developmental delays."

The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In the prospective study, 52 children (mean age 12 ±4 years) with OSAS, 10 of whom had significant developmental delays, underwent neurobehavioral assessments of sleepiness, behavioral problems, attention and quality of life at baseline and after three months of PAP treatment. Adherence with PAP treatment varied widely, with an average use of 170+145 minutes per night.

PAP treatment was associated with significant improvements in attention deficits, behavior, sleepiness and caregiver- and child-reported quality of life. Improvements in sleepiness scores, but not in other outcomes, were significantly correlated with adherence. Similar improvements in behavioral scores were seen in the subset of children with developmental delays. Among subjects younger than seven (mean age 4.5 ±1.7 years), significant improvements were seen in sleepiness and OSAS-specific quality of life.

"OSAS in children is known to be associated with behavioral disturbances and learning deficits, but the effects of PAP therapy on these deficits have not been studied," said Dr. Marcus. "Our study is the first to demonstrate that PAP therapy results in significant improvements in a range of neurobehavioral domains in these patients, including those with developmental delays."

The study had several limitations, including the lack of a placebo group, the use of reports from subjects and caregivers only, and the lack of blinding.

"The improvements we observed in daytime sleepiness, attention, internalizing behaviors and quality of life occurred despite a mean use of PAP of only three hours a night," said Dr. Marcus. "This suggests that PAP use should be encouraged in children with OSAS, even in those with suboptimal adherence, as it can lead to improvements in function that can in turn affect family, social and school function."

About the American Journal of Respiratory and Critical Care Medicine:

With an impact factor of 10.191, the AJRRCM is a peer-reviewed journal published by the American Thoracic Society.It aims to publish the most innovative science and the highest quality reviews, practice guidelines and statements in the pulmonary, critical care and sleep-related fields.

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy.

Nathaniel Dunford | EurekAlert!
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