Continuous positive airway pressure improves work of breathing in pediatric chronic heart failure

Alessandro Amaddeo; Diala Khraiche; Sonia Khirani; Mathilde Meot; Jean-Philippe Jais; Damien Bonnet; Brigitte Fauroux

doi:10.1016/j.sleep.2021.04.003

Continuous positive airway pressure improves work of breathing in pediatric chronic heart failure

Sleep Med. 2021 Jul:83:99-105. doi: 10.1016/j.sleep.2021.04.003. Epub 2021 Apr 19.

Authors

Alessandro Amaddeo¹, Diala Khraiche², Sonia Khirani³, Mathilde Meot², Jean-Philippe Jais⁴, Damien Bonnet⁵, Brigitte Fauroux⁶

Affiliations

¹ Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades F-75015, Paris, France; Université de Paris, VIFASOM F-75004, Paris, France. Electronic address: alessandro.amaddeo@aphp.fr.
² Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker-Enfants Malades, Paris, France.
³ Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades F-75015, Paris, France.
⁴ INSERM U1163, Imagine Institute, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France; AP-HP, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France.
⁵ Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France.
⁶ Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades F-75015, Paris, France; Université de Paris, VIFASOM F-75004, Paris, France.

PMID: 33991896
DOI: 10.1016/j.sleep.2021.04.003

Abstract

Background: Sleep disordered breathing (SDB) is common in adults with chronic heart failure (CHF), but its prevalence in children remains unclear. Continuous positive airway pressure (CPAP) is the treatment of SDB but deleterious hemodynamic effects have been reported.

Methods: We prospectively analyzed SDB in children with CHF and the effect of CPAP on work of breathing (WOB) and cardiac index (CI). Children aged 6 months to 18 years old with CHF due to: 1) dilated cardiomyopathy (DM) with an ejection fraction < 45%, 2) functional single ventricle (SV) or 3) aortic or mitral valve disease awaiting surgery (VD) were eligible for the study. A polysomnography (PSG), measurement of WOB and CI during spontaneous breathing (SB) and CPAP (6, 8 and 10 cmH₂O) were performed.

Results: Thirty patients with mean age of 6.4 ± 5 years were included (16 DM 16, 10 SV, 4 LV). Twenty (73%) patients had a normal sleep efficiency. Median apnoeas hypopnea index (IAH) was within normal range at 1.6 events/h (0, 14) events/hour. Only one patient had central sleep apnoeas, none had Cheyne-Stokes respiration, and 3 patients had an obstructive AHI between 5 and 10 events/hour. Optimal CPAP level decreased WOB (p = 0.05) and respiratory rate (p = 0.01).

Conclusions: Severe SDB was uncommon in children with CHF. However, CPAP may be beneficial by decreasing WOB and respiratory rate without deleterious effects on CI.

Keywords: Continuous positive airway pressure; Dilated cardiomyopathy; Single ventricle; Sleep; Valvular disease; Work of breathing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cheyne-Stokes Respiration / therapy
Child
Child, Preschool
Continuous Positive Airway Pressure*
Heart Failure* / complications
Heart Failure* / therapy
Humans
Infant
Polysomnography
Work of Breathing