Paediatric long term continuous positive airway pressure and noninvasive ventilation in France: A cross-sectional study

Abstract

Objective: To describe the characteristics of children treated with long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in France.

Design: Cross-sectional national survey.

Setting: Paediatric CPAP/NIV teams of 28 tertiary university hospitals in France.

Patients: Children aged <20 years treated with CPAP/NIV since at least 3 months on June 1st, 2019.

Intervention: An anonymous questionnaire was filled in for every patient.

Results: The data of 1447 patients (60% boys), mean age 9.8 ± 5.8 years were analysed. The most frequent underlying disorders were: upper airway obstruction (46%), neuromuscular disease (28%), disorder of the central nervous system (13%), cardiorespiratory disorder (7%), and congenital bone disease (4%). Forty-five percent of the patients were treated with CPAP and 55% with NIV. Treatment was initiated electively for 92% of children, while 8% started during an acute illness. A poly(somno)graphy (P(S)G) was performed prior to treatment initiation in 26%, 36% had a P(S)G with transcutaneous carbon dioxide monitoring (PtcCO₂), while 23% had only a pulse oximetry (SpO₂) with PtcCO₂ recording. The decision of CPAP/NIV initiation during an elective setting was based on the apnea-hypopnea index (AHI) in 41% of patients, SpO₂ and PtcCO₂ in 25% of patients, and AHI with PtcCO₂ in 25% of patients. Objective adherence was excellent with a mean use of 7.6 ± 3.2 h/night. Duration of CPAP/NIV was 2.7 ± 2.9 years at the time of the survey.

Conclusion: This survey shows the large number of children treated with long term CPAP/NIV in France with numerous children having disorders other than neuromuscular diseases.

Keywords: Continuous positive airway pressure; Home care; Noninvasive ventilation; Obstructive sleep apnea; Sleep-disordered breathing.