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Background: Regular care and cleaning of positive airway pressure (PAP) devices are important for maintaining equipment in the home. Illness and hospitalization have occurred from inadequate cleaning and use of tap water in the humidifier. In recent years, ozone and ultraviolent-light disinfection devices have been advertised for cleaning home PAP equipment. Our clinic provides instructions; however, cleaning practices performed in the home are unknown., Methods: A survey of home cleaning practices for PAP equipment was conducted in a pediatric sleep clinic during 2019-2020. Survey domains were method, cleaning and replacement frequency for each component, type of water used, instruction preferences, and demographics. The primary aim was to identify home PAP cleaning practices and compare with provided instructions. The secondary aim was to determine if respiratory-related symptoms (eg, congestion, runny nose, sneezing, coughing) occurred or increased with PAP use or inadequate cleaning., Results: The survey was completed by 96 respondents. Most reported weekly cleaning of mask (36, 38%), tubing (41, 43%), and humidifier (31, 33%) with soap and water as the primary method for each. The majority used distilled water in the humidifier (74, 77%) and reported respiratory symptoms did not occur with PAP use (64, 67%). Very few indicated a device was used to clean equipment. No associations were found between length of time for PAP use and cleaning practices. There was a moderately low correlation between age and cleaning. Increased age was associated with decreased cleaning frequency (r = 0.20, P = .048)., Conclusions: Care and cleaning practices of home PAP equipment varied from instructions provided in clinic. Most reported at least weekly cleaning of items for which daily cleaning is recommended. Few reported using a device for cleaning or having respiratory symptoms from PAP treatment., Competing Interests: Ms Willis is a section editor for Respiratory Care. The remaining authors have disclosed no conflicts of interest., (Copyright © 2023 by Daedalus Enterprises.)

Background: Obstructive sleep apnea (OSA) is diagnosed through polysomnography (PSG) testing and commonly treated with positive airway pressure (PAP). The initial recommended treatment for pediatric OSA is adenotonsillectomy, but when this is contraindicated or ineffective, PAP is the next option. Children followed in our pediatric sleep disorders center who are diagnosed with OSA and meet criteria for therapy are empirically prescribed a PAP device, usually auto-titrating PAP (APAP), to avoid delays in therapy. Titration PSG is performed later to assess adequacy of settings. The aims of this study were to determine how often PSG titration results in changes to empirically prescribed PAP and to assess adherence to therapy before and after PSG titration., Methods: A retrospective medical records review was completed for children diagnosed with OSA, prescribed PAP, and had a titration PSG within a 5-y consecutive period of 2008-2012. Demographic data, type of device, pressure settings, and adherence downloads were reviewed. Adherence was assessed before and after titration overall and compared for those who did and did not have therapy changes following titration., Results: The study included 121 participants. Median age at the time of the diagnostic PSG was 11 (interquartile range [IQR] 8-14) y. Most (106, 88%) were initially prescribed APAP. Median length of time between initial and follow-up PSG was 6.4 (IQR 4.4-10.1) months. The majority (94, 78%) had therapy changes following titration. Overall, adherence percentage > 4 h per night was not significantly increased post titration (P = .47). There were no statistically significant differences in adherence between those who had therapy changes and those who did not (P = .26)., Conclusions: Titration studies resulted in therapy modifications for most children. Adherence was not increased following the titration PSG. Changes in therapy did not result in increased adherence. Titration PSGs may optimize empirically prescribed settings., Competing Interests: Ms Willis serves as Section Editor for Respiratory Care. The authors have disclosed no other conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)

Purpose: Sleep related breathing disorders (SRBD) are seen at disproportionately higher rates in children with spina bifida compared with their same aged peers. SRBD such as obstructive sleep apnea (OSA) or central apnea are associated with developmental and cognitive consequences, and sudden death., Methods: Participants aged 1 to 20 years with a diagnosis of spina bifida were recruited from a pediatric academic hospital spinal cord specialty clinic to evaluate the prevalence and impact of sleep disorders in the spina bifida population; 76 polysomnogram (PSG) reports spanning a 3-year period were reviewed in this retrospective cohort study., Results: Of the PSGs reviewed, 37 (49%) indicated the presence of SRBD, and 28 (76%) of those children required an escalation of management (surgical intervention or additional respiratory support). These results are consistent with previous studies and further emphasize the clinical impact of SRBD on children with spina bifida by describing the interventions that followed an abnormal PSG., Conclusion: The high prevalence of SRBD in the spina bifida population supports the need for additional research to develop sleep questionnaires specific to spina bifida that can predict abnormal PSG clinically and to determine the standard of care following an abnormal PSG, chiefly in OSA and central apnea.

Study Objectives: To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA)., Methods: At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Presurgery and postsurgery OPSG indices were compared. We defined cure as an apneahypopnea index (AHI) < 1.5/h on the postsurgery OPSG, and we compared the cure rates of different surgeries., Results: A total of 143 children, median age 12.4 y (interquartile range [IQR] 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 y [IQR 9-15]) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT + turbinate trim ± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor., Conclusions: Surgery improved OPSG indices in the majority of obese children with OSA., (© 2015 American Academy of Sleep Medicine.)

Objectives: Positive Airway Pressure (PAP) devices are being increasingly used in pediatric populations for problems including Obstructive Sleep Apnea. There is limited literature regarding pediatric adherence with PAP treatment or successful interventions that improve adherence. This paper describes a clinical program for pediatric PAP users which was designed to improve adherence of patients prescribed PAP therapy and involves intensive assessment and behavioral intervention., Method: The design and implementation of the program is described, including the purpose, goals, programmatic structure, clinical content, type and training of personnel, strengths and limitations and financial concerns as well as the challenges with the development and application of the program's protocol., Results: Preliminary outcome data show short-term improvements in consistent usage for many of the patients., Conclusions: The program shows some promise and provides a framework for future program development and research.

Application of positive airway pressure is frequently indicated in pediatric patients with a diagnosis of obstructive sleep apnea. Adherence to equipment use is often less than optimal and can be more challenging when working with children with special needs. An in-patient protocol was designed utilizing various techniques and strategies from the medical adherence literature and applied to 2 cases. This protocol utilizes specialists from various disciplines, including respiratory therapists, psychologists, physicians, nurses, and child life therapists, as well as parental involvement. This paper outlines this protocol using 2 case studies. Both patients successfully used their equipment for greater than 4 hours at night by the end of their hospital stay of 4 days and maintained or advanced these gains at follow-up. These 2 cases suggest that more research should be conducted to further evaluate the effectiveness of similar programs.

Obstructive sleep-disordered breathing is associated with upper airway obstruction during sleep, which negatively affects sleep quality, ventilation, and/or oxygenation. The condition affects 2-11% of children. In this paper we discuss the epidemiology, pathophysiology, clinical features, diagnosis, and management of obstructive sleep-disordered breathing in children and provide a brief overview of the Arkansas Children's Hospital Sleep Disorder Center.