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INNOVATIVE TREATMENT OF OBSTRUCTIVE SLEEP APNEA IN DOWN SYNDROME

Cooper Hospital University Medical Center, Camden, NJ

PURPOSE: Down Syndrome is a common genetic disorder with an incidence of 1 in 600-800 live births. Children and infants with this syndrome have a high incidence (15-50%) of Obstructive Sleep Apnea Syndrome (OSAS). OSAS in these children is often diagnosed late. Polysomnograms (PSG) are often difficult to perform because of behavioral and developmental problems. Tolerance of BiPAP via mask is very low, especially in infants. Children with Down Syndrome, unlike children with isolated OSAS, are a higher operative risk and also continue to have abnormal PSGs after adenotonsillectomy.

METHODS: We present a 3 y.o. with Down Syndrome. He was admitted with cardio- respiratory problems several times in infancy, both before and after VSD closure, with diagosis of pneumonia, respiratory distress, and asthma. During his last admission he was noticed to be obstructing only while asleep. He was started on BiPAP several times without success because of poor tolerance of the mask. Since he tolerated O2 via nasal cannula he was tried on a high flow device (Vapotherm). He was placed on 8L O2 via Vapotherm with improvement of symptoms. He was subsequently discharged on Vapotherm at nap and sleep times.

RESULTS: He had a 12 channel PSG using a standard PSG system interfaced with the Vapotherm functioning as CPAP. A modified PSG was performed which showed an Apnea index of 1.6 and a RDI 11.1 with low sat of 68.8% during the diagnostic part of the split study. This improved to an apnea index of 0 and an RDI of 0.5% with a low sat of 78.5% on 9L compressed air via Vapotherm with 1.5L O2. There were no desaturations after O2 was added.

CONCLUSION: The Vapotherm offers a viable alternative to nasal or full-face mask for application of positive pressure in infants and young children with OSAS.

CLINICAL IMPLICATIONS: Vapotherm offers an alternative treatment and/or a way to postpone surgical treatment of craniofacial anomalies in children with Down syndrome.

DISCLOSURE: Jennifer Miller, None.