Good Night, Sleep Tight, Breathe Right

PAP therapy for children with sleep apnea improves behavior and development

(RxWiki News) The standard therapy for obstructive sleep apnea isn't just for adults: children as young as 7 years old can reap significant benefits even from inconsistent use of PAP.

In a recent study, children experienced increased quality of life and decreased sleepiness, behavioral issues and attention symptoms when their sleep apnea was treated with positive airway pressure, or PAP .

"Kids can have sleep apnea too.."

The study's lead author, Dr. Carole Marcus, a pediatrics professor at the Children's Hospital of Philadelphia, and her colleagues assessed 52 children who had severe obstructive sleep apnea, ranging from 8 to 16 years old.

About 70 percent of the children were obese, and ten children had neurodevelopment disabilities, including six children with Down syndrome, one with Prader-Willi syndrome, one with cerebral palsy, one with autism and one with a chromosomal disorder.

Marcus's team used standard clinical scales to assess how sleepy the children were during the day, any behavioral problems they exhibited, their level of ADHD and their quality of life both before PAP use and after three months of PAP use.

The children's use of PAP varied considerably but averaged about three hours a night.

After three months, the children had decreased sleepiness, decreased attention deficit symptoms and improved behavior. Both the children and their parents reported better quality of life according to two clinical scales as well.

The researchers saw similar improvements within the group of children who had developmental disorders.

Marcus said obstructive sleep apnea in children is already known to be associated with behavioral and learning difficulties, but no studies so far have studied the impact of PAP therapy specifically on these conditions for children.

"Our study is the first to demonstrate that PAP therapy results in significant improvements in a range of neurobehavioral domains in these patients, including those with developmental delays," Marcus said.

The researchers also studied a subset of 7 children between the ages of 2 to 6, though PAP is not approved by the FDA for for the general public if children are under age 7 or under 40 pounds. These younger children also showed decreased sleepiness and increased quality of life.

Dr. William Kohler, M.D., director of the Florida Sleep Institute and director of Pediatric Sleep Services at Florida Hospital Tampa, said past research had already shown that increasing sleep quantity and quality improves neurobehavioral outcomes and behavior.

However, the improvements in the children's development in this study are noteworthy especially since some of the children only used the PAP for a relatively brief period of time rather than the whole night, as recommended.

"This shows that any improvement in the sleep disordered breathing will potentially have a positive outcome in the child's development, which is very exciting proof of the importance of diagnosing early and treating appropriately any type of sleep disordered breathing or other sleep impediments," Kohler said.

The study was limited by the fact that the researchers did not use a placebo group and used self-reporting for their assessments. However, they concluded that PAP therapy was beneficial for children suffering from obstructive sleep apnea.

"The treatment of childhood OSAS with PAP therapy was associated with significant improvements in daytime sleepiness, symptoms of ADHD, internalizing behaviors and quality of life in children with OSAS, including young children and children with developmental delays," they wrote.

They said these benefits were seen despite an average use among the children of only three hours each night, so doctors should encourage any use of PAP, even if it's not as consistently as recommended.

The study was published online ahead of print in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

The study was funded by Philips Respironics, which manufacturers PAP and other sleeping aid equipment, and from a National Institutes of Health grant.

The authors did not state any financial conflicts of interest.

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Review Date: 
February 9, 2012