Wearing a special mask to bed helps children with sleep apnea breathe and sleep better, but a small, six-month study at Johns Hopkins Children's Center and two other pediatric hospitals suggests children aren't always using them consistently enough to reap the maximum benefits.
The breathing masks, which deliver a gentle, steady flow of air called positive airway pressure (PAP) therapy, significantly improved breathing and oxygen levels when worn regularly, researchers report in the March issue of Pediatrics. Parents also reported that their children had improved daytime alertness at school. Sleep apnea is marked by loud snoring and disturbed sleep caused by interrupted breathing patterns.
"Despite improvements with even irregular use of the device, parents often say children are using PAP when the study shows they are not," says investigator Ann Halbower, M.D., pediatric pulmonologist at the Johns Hopkins Children's Center. "Obstructive sleep apnea can cause learning, memory and IQ problems. Additionally, it affects breathing and oxygen levels, and while PAP therapy helps the apnea, the maximum benefits come only over time and with consistent use."
For the study, researchers enrolled 29 children between 2 and 16 years of age and instructed them to use the PAP masks at home every night. The 29 children underwent a baseline sleep study at enrollment, and 20 of them returned for a follow-up sleep study after six months. In addition, investigators surveyed the parents of the 20 children who completed the study to get their account of usage, and also tallied recorded usage data built into the PAP devices.
Comparing baseline and follow-up measures, researchers found a nine-fold average decrease in children's apnea hypopnea index (AHI), which represents the number of interruptions in breathing per hour. Oxygen saturation improved by an average 12 percent.
"What this means is that with treatment, sleep apnea basically went from severe to mild or better," Halbower says.
It remains unclear how PAP therapy affects neurocognitive performance, even though parents reported improved alertness and dramatic reduction in the percentage of children who fell asleep during school at least once a week. Halbower cautions that these outcomes are based on subjective reports, and further studies are needed to document objectively the device's effect on neurocognitive function. There was no difference in reported academic performance, irritability or hyperactivity.