Objective The aim of the study was to describe the characteristics of otherwise healthy children with obstructive sleep apnea (OSA; OSA-I) and children with OSA and obesity (OSA-II) treated with long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in 2019 in France. Design National cross-sectional survey. Patients Children with OSA-I and OSA-II. Main outcome measures Initiation criteria, age, adherence, equipment and settings Results Patients with OSA-I and OSA-II represented 6% (n=84, 71% males) and 10% (n=144, 72% males) of the national cohort, respectively. The apnea-hypopnea index (63% vs 76%), alone or combined with nocturnal gas exchange (25% vs 21%, for OSA-II and OSA-I patients respectively) were used as initiation criteria of CPAP/NIV. OSA-II patients were older at CPAP/NIV initiation (mean age 11.0±4.0 vs 6.8±4.5 years, p<0.001) and were treated for a longer time (2.3±2.6 vs 1.3±1.5 years, p=0.008) than OSA-I patients. NIV was used in 6% of OSA-I patients and 13% of OSA-II patients (p=0.142). Nasal mask was the most used interface in both groups. Mean CPAP level was higher in OSA-II patients as compared to OSA-I patients (8.7±2.0 vs 7.7±2.4 cmH 2O, p=0.02). Objective compliance was comparable (mean use 6.8±2.6 vs 5.9±3.0 hours/night in OSA-I and OSA-II, respectively, p=0.054). Conclusion Six and 10% of children treated with long term CPAP/NIV in France in 2019 had OSA-I and OSA-II, respectively. Both groups were preferentially treated with CPAP and were comparable except for age, with OSA-II patients being older.

Background: It is unclear whether sensitization patterns differentiate children with severe recurrent wheeze (SRW) / severe asthma (SA) from those with non-severe recurrent wheeze (NSRW) / non-severe asthma (NSA). Our objective was to compare the sensitization patterns between children with SRW/SA and NSRW/NSA from the French COBRAPed cohort. Methods: IgE to 112 components (c-sIgE) (ImmunoCAP® ISAC) were analyzed in 125 preschool (3-6 years) and 170 school-age children (7-12 years). Supervised analyses and clustering methods were applied to identify patterns of sensitization among children with positive c-sIgE. Results: We observed c-sIgE sensitization in 51% of preschool and 75% of school-age children. Sensitization to house dust mite (HDM) components was more frequent among NSRW than SRW (53% vs 24%, p<0.01). Sensitization to non-specific lipid transfer protein (nsLTP) components was more frequent among SA than NSA (16% vs 4%, p<0.01) and associated with a FEV1/FVC <-1.64 z-score. Among sensitized children, seven clusters with varying patterns were identified. The two broader clusters identified in each age group were characterized by “few sensitizations, mainly to HDM”. One cluster (n=4) with “multiple sensitizations, mainly to grass pollen, HDM, PR-10, and nsLTP” was associated with SA in school-age children. Conclusions: Although children with wheeze/asthma display frequent occurrences and high levels of sensitization, the sensitization patterns did not clearly discriminate children with severe disease from those with milder disease. These results suggest that the severity of wheeze/asthma may depend on both IgE- and non-IgE-mediated mechanisms.

Introduction: Periodic breathing (PB) is considered physiological in the neonatal period but must disappear in the first months of life. Few data regarding PB after the neonatal period are available. The objective of this study was to describe the clinical and polysomnographic characteristics of infants presenting with PB after the age of 1 month. Methods: This French multicenter retrospective case series included infants born at term between 2012 and 2021, without underlying disease, and who presented during a polysomnography (PSG) recording more than 1% of PB after 1 month of life. Results: Overall, 10 infants were included, they underwent a PSG for brief resolved unexplained event, desaturation, pauses in breathing, cyanosis, and/or signs of respiratory distress. The percentage of total sleep time spent with PB was 18.1% before 3 months (n=7), 4.7% between 3 and 6 months (n=10), 7.1% between 7 and 12 months (n=2), and 0% after 12 months (n=2). During the first PSG, ≥ 3% desaturations were observed in 77% to 100% of the PB episodes. At the first PSG, 9/10 infants had an obstructive apnea hypopnea index > 10/h and 5/10 had a central apnea index > 5/h. Gastro-esophageal reflux (GER) was suspected in 8/10 infants. All infants showed improvement in initial symptoms during the first year of life. Conclusion: Although PB is rare after 1 month of age, the present study shows that when present, PB is most frequently associated with obstructive and/or central apnea syndrome in term infants without comorbidities other than GER.