1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2023, Issue 1
  5. Article
Volume 2023, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Long-term noninvasive ventilation (NIV) is being progressively used in children. The current guidelines recommend NIV initiation in the hospital during overnight polysomnography (PSG) titration study. Due to the logistic, socioeconomic, and financial difficulties including bed availability, an outpatient program for NIV initiation and patients/parents counseling to prevent delay and provide cost-effective care has been commissioned. Hence, this study reports on the clinical outcome of our program as it represents the first reported experience from the middle east.

A retrospective review of electronic medical charts was conducted for all patients with PSG-confirmed sleep-related breathing disorders (SRBD) who were evaluated and treated in the NIV clinic in the pediatric pulmonary clinic at Sidra Medicine from January 2020 to November 2021. Patients’ data included demographics, PSG results, and NIV clinic records. The results show that twenty-eight patients (17 male, 11 female) were included during the study period. The patients’ median age at NIV initiation was 11 ± 5.17 years. The median BMI was 32.72 ± 15.91 kg/m2. The most common diagnosis was morbid obesity in 9 (32%) of the patients. The identified SRBD based on the diagnostic PSG were obstructive sleep apnea in 21 patients, hypoventilation in 3 patients, mixed apnea in 3 patients, and central apnea in 1 patient. The median total Apnea-Hypopnea Index (AHI) was 12.7 (0.7-153.9) events per hour. The main reason for the initial NIV clinic visit was NIV initiation in 19 patients. Upon follow-up, six patients were successfully weaned off NIV support by the treating pulmonologist. Five patients refused to use NIV at home. Fifteen out of the remaining seventeen patients used NIV ≥  4 hours per night (subjective adherence: 88%). Twelve patients used the NIV for ≥  24 nights per month (70.6%). All parents reported that the clinic experience was beneficial and helped them to be more comfortable with applying the NIV machine at home. In conclusion, pediatric NIV outpatient programs are achievable and beneficial, especially in developing countries. Pediatric NIV clinics managed by a specialized and experienced team play important role in the initiation and follow-up of NIV support. They provide alternative pathways for the care of pediatric patients, education, and support of their families, and decrease the load on intensive care and sleep laboratory units. Studies about cost-effectiveness are needed to evaluate the impact of implementing outpatient NIV programs on sleep laboratories and hospital admission rates.

© 2023 AlNaimi, Hamad, Arar, Mandanas, Abu-Hassan, licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2023.5
2022-12-30
2024-11-08
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2023/1/qmj.2023.5.html?itemId=/content/journals/10.5339/qmj.2023.5&mimeType=html&fmt=ahah

References

  1. Amin RS, Donnelly LF, Beebe D, et al. Sleep-related breathing disorders in children. In: Randerath WJ, Sanner BM, Somers VK (eds). Sleep Apnea. Basel, Karger, 2006, vol. 35:, pp. 204–214.
     [Google Scholar]
  2. 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;4:157–171.
     [Google Scholar]
  3. Massa F, Gonsalez S, Laverty A, et al. The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea. Arch Dis Child. 2002;87:438–443.
     [Google Scholar]
  4. Kushida CA, Chediak A, Berry RB, et al. Positive Airway Pressure Titration Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008; 4:(2):157–171. Published 2008 Apr 15.
     [Google Scholar]
  5. Markström A, Sundell K, Lysdahl M, et al. Quality-of-life evaluation of patients with neuromuscular and skeletal diseases treated with noninvasive and invasive home mechanical ventilation. Chest. 2002;1221695–1700.
     [Google Scholar]
  6. Rose L, McKim DA, Katz SL, et al. Home mechanical ventilation in Canada: a national survey. Respir Care. 2015; 60:(5):695–704. Published 2015 May 1.
     [Google Scholar]
  7. Girbal IC, Gonçalves C, Nunes T, et al. Non-invasive ventilation in complex obstructive sleep apnea–A 15-year experience of a pediatric tertiary center. Rev Port Pneumol. 2014; 20:(3):146–151. Published 2014 May 1.
     [Google Scholar]
  8. Amaddeo A, Frapin A, Touil S, et al. Outpatient initiation of long-term continuous positive airway pressure in children. Pediatr Pulmonol. 2018 Oct; 53:(10):1422–1428.
     [Google Scholar]
  9. Nixon GM, Mihai R, Verginis N, et al. Patterns of continuous positive airway pressure adherence during the first 3 months of treatment in children. J Pediatr. 2011;159802–807.
     [Google Scholar]
  10. Machaalani R, Evans CA, Waters KA. Objective adherence to positive airway pressure therapy in an Australian paediatric cohort. Sleep Breath. 2016 Dec;201327–1336.
     [Google Scholar]
  11. Mihai R, Vandeleur M, Pecoraro S, et al. Autotitrating CPAP as a tool for CPAP initiation for children. J Clin Sleep Med. 2017; 13:(5):713–719. Published 2017 May 15.
     [Google Scholar]
  12. Riley EB, Fieldston ES, Xanthopoulos MS, et al. Financial analysis of an intensive pediatric continuous positive airway pressure program. Sleep. 2017; 40:(2):zsw051. Published 2017 Feb 1.
     [Google Scholar]
  13. Al Khal A, Al-Kaabi S, Checketts RJ. Qatar's response to COVID-19 pandemic. Heart Views. 2020 Jul; l21:(3):129–132.
     [Google Scholar]
  14. Kribbs NB, Pack AI, Kline LR, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 Apr; 147:(4):887–895.
     [Google Scholar]
  15. Choi JA, Yoon IY, Han EG, et al. Subjective and objective CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Med Res. 2011; 2:(2):63–68. Published 2011 Aug 31.
     [Google Scholar]
  16. Hawkins SM, Jensen EL, Simon SL, et al. Correlates of pediatric CPAP adherence. J Clin Sleep Med. 2016 Jun 15; 12:(6):879–884. Published 2016 Jun 15.
     [Google Scholar]
  17. Marcus CL, Rosen G, Ward SLD, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006 Mar; 117:(3):e442–e451.
     [Google Scholar]
  18. O'Donnell AR, Bjornson CL, Bohn SG, et al. Compliance rates in children using noninvasive continuous positive airway pressure. Sleep. 2006; 29:(5):651–658. Published 2006 May 1.
     [Google Scholar]
  19. Beebe DW, Byars KC. Adolescents with obstructive sleep apnea adhere poorly to positive airway pressure (PAP), but PAP users show improved attention and school performance. PloS One. 2011 Mar 17; 6:(3):e16924. Published 2011 Mar 17.
     [Google Scholar]
  20. DiFeo N, Meltzer LJ, Beck SE, et al. Predictors of positive airway pressure therapy adherence in children: a prospective study. J Clin Sleep Med. 2012; 8:(3):279–286. Published 2012 Jun 15.
     [Google Scholar]
  21. Jambhekar SK, Com G, Tang X, et al. Role of a respiratory therapist in improving adherence to positive airway pressure treatment in a pediatric sleep apnea clinic. Respir Care. 2013; 58:(12):2038–2044. Published 2013 Dec 1.
     [Google Scholar]
  22. Pasquina P, Adler D, Farr P, et al. What does built-in software of home ventilators tell us? An observational study of 150 patients on home ventilation. Respiration. 2012; 83:(4):293–299.
     [Google Scholar]
  23. Ramirez A, Khirani S, Aloui S, et al. Continuous positive airway pressure and noninvasive ventilation adherence in children. Sleep Med. 2013; 14:(12):1290–1294. Published 2013 Dec 1.
     [Google Scholar]
/content/journals/10.5339/qmj.2023.5
Loading
Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East
Qatar Medical Journal 2023, 5 (2023); https://doi.org/10.5339/qmj.2023.5
/content/journals/10.5339/qmj.2023.5
/content/journals/10.5339/qmj.2023.5
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): Non-invasive ventilation, outpatient and pediatric

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error