CPAP Treatment in Children

  • Dafna OferEmail author
  • Carole L. Marcus
Part of the Respiratory Medicine book series (RM)


Obstructive sleep apnea syndrome (OSAS) is a relatively common disorder, occurring in 1–4% of otherwise healthy children, with a higher prevalence in children with underlying medical conditions such as obesity or genetic syndromes. The standard treatment for childhood OSAS is adenotonsillectomy. However, further treatment is required in many children, particularly children with comorbid medical conditions. Continuous positive airway pressure (CPAP) is the usual treatment for those children who do not respond to adenotonsillectomy or the few children who are not candidates for surgery. It is less than 30 years since CPAP was first used for the treatment of OSAS in adults, and only recently has it been used systematically in children. CPAP treatment can effectively treat OSAS in children, improving both nocturnal and daytime symptoms. However, poor adherence is a limiting factor. The process of CPAP initiation, habituation, and maintenance in children involves multidisciplinary teamwork. Because of the relatively short time period since the introduction of CPAP in children, and the relative small number of children who have received CPAP treatment until recently, much research in the area is required.


Continuous Positive Airway Pressure Obstructive Sleep Apnea Syndrome Continuous Positive Airway Pressure Therapy Continuous Positive Airway Pressure Treatment Rapid Maxillary Expansion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Schmidt-Nowara WW. Continuous positive airway pressure for long-term treatment of sleep apnea. Am J Dis Child. 1984;138(1):82–4.PubMedGoogle Scholar
  3. 3.
    Guilleminault C, Nino-Murcia G, Heldt G, Baldwin R, Hutchinson D. Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children. Pediatrics. 1986;78(5):797–802.PubMedGoogle Scholar
  4. 4.
    Farber JM. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109(4):704–12.CrossRefGoogle Scholar
  5. 5.
    Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149(6):803–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Hoban TF. Polysomnography should be required both before and after adenotonsillectomy for childhood sleep disordered breathing. J Clin Sleep Med. 2007;3(7):675–7.PubMedGoogle Scholar
  7. 7.
    Kalra M, Inge T. Effect of bariatric surgery on obstructive sleep apnoea in adolescents. Paediatr Respir Rev. 2006;7(4):260–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics. 2006;117(1): e61–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep. 2004;27(4):761–6.PubMedGoogle Scholar
  10. 10.
    Villa MP, Malagola C, Pagani J, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med. 2007; 8(2):128–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Marcus CL, Ward SL, Mallory GB, et al. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr. 1995; 127(1):88–94.PubMedCrossRefGoogle Scholar
  12. 12.
    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of OSA in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–53.PubMedGoogle Scholar
  14. 14.
    Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med. 2005;165(4):447–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Uong EC, Epperson M, Bathon SA, Jeffe DB. Adherence to nasal positive airway pressure therapy among school-aged children and adolescents with obstructive sleep apnea syndrome. Pediatrics. 2007;120(5):e1203–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Marcus CL, Rosen G, Ward SL, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006;117(3):e442–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Massa F, Gonsalez S, Laverty A, Wallis C, Lane R. The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea. Arch Dis Child. 2002;87(5):438–43.PubMedCrossRefGoogle Scholar
  18. 18.
    Downey 3rd R, Perkin RM, MacQuarrie J. Nasal continuous positive airway pressure use in children with obstructive sleep apnea younger than 2 years of age. Chest. 2000;117(6):1608–12.PubMedCrossRefGoogle Scholar
  19. 19.
    Guilleminault C, Pelayo R, Clerk A, Leger D, Bocian RC. Home nasal continuous positive airway pressure in infants with sleep-disordered breathing. J Pediatr. 1995;127(6):905–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Waters KA, Everett FM, Bruderer JW, Sullivan CE. Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med. 1995;152(2):780–5.PubMedGoogle Scholar
  21. 21.
    Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998;102(3 Pt 1):616–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Gozal D, Pope Jr DW. Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics. 2001;107(6):1394–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Marcus CL, Radcliffe J, Konstantinopoulou S, Beck SE, Cornaglia MA, Traylor J, DiFeo N, Karamessinis LR,, Gallagher PR, Meltzer LJ. Effects of positive airway pressure therapy on neurobehavioral outcomes in children with obstructive sleep apnea. Am J Respir Crit Care Med 185;9:998–1003.Google Scholar
  24. 24.
    Hsiao KH, Nixon GM. The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy. Res Dev Disabil. 2007;29:133–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Weaver TE, Kribbs NB, Pack AI, et al. Night-to-night variability in CPAP use over the first three months of treatment. Sleep. 1997;20(4):278–83.PubMedGoogle Scholar
  26. 26.
    Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2): 173–8.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Donnell AR, Bjornson CL, Bohn SG, Kirk VG. Compliance rates in children using noninvasive continuous positive airway pressure. Sleep. 2006;29(5):651–8.PubMedGoogle Scholar
  28. 28.
    Koontz KL, Slifer KJ, Cataldo MD, Marcus CL. Improving pediatric compliance with positive airway pressure therapy: the impact of behavioral intervention. Sleep. 2003;26(8):1010–5.PubMedGoogle Scholar
  29. 29.
    Difeo NE, Meltzer LJ, Karamessinis LR, Michelle P, Walker CF, Schultz BJ, Samuel J, Traylor J, Marcus CL. Factors affecting positive airway pressure (PAP) adherence in children. Sleep. 2008;31(Supplement):A90.Google Scholar
  30. 30.
    Constantinidis J, Knobber D, Steinhart H, Kuhn J, Iro H. Fine-structural investigations of the effect of nCPAP-mask application on the nasal mucosa. Acta Otolaryngol. 2000;120(3):432–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Massie CA, Hart RW, Peralez K, Richards GN. Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest. 1999;116(2):403–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Mador MJ, Krauza M, Pervez A, Pierce D, Braun M. Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure. Chest. 2005; 128(4):2151–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Li KK, Riley RW, Guilleminault C. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia. Chest. 2000;117(3):916–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Fauroux B, Lavis JF, Nicot F, et al. Facial side effects during noninvasive positive pressure ventilation in children. Intensive Care Med. 2005;31(7):965–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Choo-Kang LR, Ogunlesi FO, McGrath-Morrow SA, Crawford TO, Marcus CL. Recurrent pneumothoraces associated with nocturnal noninvasive ventilation in a patient with muscular dystrophy. Pediatr Pulmonol. 2002;34(1):73–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Harrison W, Pence N, Kovacich S. Anterior segment complications secondary to continuous positive airway pressure machine treatment in patients with obstructive sleep apnea. Optometry. 2007;78(7):352–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Kadyan A, Asghar J, Dowson L, Sandramouli S. Ocular findings in sleep apnoea patients using continuous positive airway pressure. Eye (Lond). 2010;24(5):843–50.CrossRefGoogle Scholar
  38. 38.
    Cannon PS, Madge SN, Selva D. Air regurgitation in patients on continuous positive airway pressure (CPAP) therapy following dacrocystorhinostomy with or without Lester-Jones tube insertion. Br J Ophthalmol. 2010;94(7):891–3.PubMedCrossRefGoogle Scholar
  39. 39.
    Palombini L, Pelayo R, Guilleminault C. Efficacy of automated continuous positive airway pressure in children with sleep-related breathing disorders in an attended setting. Pediatrics. 2004;113(5):e412–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Kirk VG, O’Donnell AR. Continuous positive airway pressure for children: a discussion on how to maximize compliance. Sleep Med Rev. 2006;10(2):119–27.PubMedCrossRefGoogle Scholar
  41. 41.
    Budhiraja R, Parthasarathy S, Drake CL, et al. Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep. 2007;30(3):320–4.PubMedGoogle Scholar
  42. 42.
    Kushida CA, Chediak A, Berry RB, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4(2):157–71.PubMedGoogle Scholar
  43. 43.
    Marcus CL. Concerns regarding the pediatric component of the AASM clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4(6):607. author reply 8–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of Medicine, Division of Sleep MedicineThe University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Pediatrics, Children’s Hospital of PhiladelphiaThe University of PennsylvaniaPhiladelphiaUSA

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