Résumé :
|
Introduction : Obstructive sleep apnoea (OSA) is associated with significant morbidity. NIPPV has been recommended as a treatment option in children with complex situations, non eligible or waiting for surgery or in whom it was not successful. Our purpose is to show the preliminary results of a retrospective cohort survey based on the evaluation of OSA patients in which NIPPV was considered as a treatment option. Methodology : A review of the clinical files of patients on NIPPV was performed and data on age, sex, diagnosis, height and weight, age of onset of NIPPV, complications, compliance and results were analysed. Control of OSA was confirmed using sleep oxymetry or polysomnographic sleep studies. Results : 35 patients, 20 male (57,1%) were included.Median age at NIPPV beginning is 6,46 (0,2;17,9) years. Nine (25,7%) patients have craniofacial malformations 6 (17,1%) neurological diseases, 5 (14,3%) obesity, 5 (14,3%) mucopolysacharidosis, 3 (8,7%) trisomy 21, 3 (8,7%) laryngo/tracheomalacia, 2 (5,7%) Prader-Willi syndrome. Indications for NIPPV were OSA non-eligible for surgery in 23 patients (65,7%), post-surgical persistence of OSA in 10 (28,7%) and as a bridge to surgery in 2. An initial sleep study was performed in 19 patients (54,3%), mean AHI found was 12,3/h (±SD11,94). Fourteen (40%) patients were submitted to surgery, 9 before NIPPV. (Ear Nose and Throat in 12; maxillofacial in 2). Complications were found in 6 patients (25,7%) : ocular irritation (4 patients), skin ulceration (2 patients) and facial deformation (2 patients). 30 (85,7%) patients showed good compliance with NIPPV and in all control of OSA was shown. NIPPV was suspended in 7 patients by clinical improvement. Three patients died in consequence of disease natural history. Conclusion : We describe a complex group of patients and as others we have shown different coexisting factors contributing to OSA.We found few complications and good compliance to NIPPV, which resulted in clinical improvement without surgery or allowing surgery to be postponed to amore adequate timing. We suggest that good compliance is the consequence of frequent, multidisciplinary assessment. Moreover compliance probably promotes the efficacy of treatment and reduces the negative impact of OSA on health, neuropsychological development and quality of life.
|