Do children tolerate CPAP and BiPAP therapies for OSA?

Obstructive sleep apnea (OSA) can cause big problems for kids. When kids aren’t breathing well during sleep, they lose energy. They fall behind academically. Their behavior suffers and they have trouble maintaining good relationships with parents, teachers, and peers. Dental practices screen children for OSA because untreated OSA can affect a child’s entire future.

While a tonsillectomy and adenectomy are the first-line OSA treatment for most children, kids who still have sleep apnea after the surgery or kids who can’t tolerate surgery are often given a treatment plan that includes a CPAP or BPAP machine during sleep. 

However, parents are often unsure if their children will tolerate the machine. A study published in The Lancet in December 2019 studied 20,553 children to find out how well various age groups complied with PAP machines for the treatment of pediatric OSA.

The researchers found that, over 90 days, less than 62% of the children completed the study without a 30-day hiatus in PAP use. Only 46.3% of the patients used their PAPs for at least 4 hours a night on more than 70% of the nights in the study. The researchers found that this rate of compliance is typical for any long-term interventions for chronic pediatric conditions, but it’s far lower than the rate of compliance with PAP treatment in adult populations.   

Older teenagers and preschoolers had the hardest time complying with their treatment plans. Patient engagement programs improved compliance, and poor mask fit reduced compliance.  In a disturbing trend, children with higher AHI scores were less likely to comply with PAP treatment plans. This means the kids who most need help to ensure their brain gets enough oxygen during sleep are also least likely to be getting that help.

Alternatives to PAP therapies for children

If a child who has had a T&A is still suffering from sleep apnea and can’t tolerate the PAP machines, there are several alternative therapies available:

• Tongue and lip tie revision – Pediatricians have become more conservative about clipping tongue and lip ties in children. Sometimes, unrevised ties can cause the tongue to block the airway during sleep.

• Palate expansion – Children with high, narrow palates aren’t just at risk for orthodontic issues. When the tongue can’t rest on the palate during sleep, it can interfere with breathing. Additionally, high palates affect the shape of the sinus cavity and make children more vulnerable to disordered breathing from colds and allergies. There are oral appliances available to expand the palate and improve sleep breathing.
• Allergy treatments – Some children with sleep-breathing issues have poorly treated allergies. An allergist may be able to recommend medications that will improve their breathing.
• Oral myofascial therapy – Some children lack muscle tone and control, and this can close off their airways during sleep. Therapy can help them strengthen and tone the muscles of their mouth, face, and throat, correcting sleep breathing problems.

While T&A is the first-line treatment for pediatric OSA and PAP machines are the second-line treatment, many children require additional therapies or interventions to achieve healthy sleep breathing. 

Childhood is an important time for physical, intellectual, and emotional growth, and OSA impacts all of these areas of development. If you are a parent whose child needs an alternative to CPAP therapy, your pediatric dentist may be able to help you find the treatments you need.

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website: MeghnaDassani.com.