Long term ventilation into pediatric central apneas: etiologies,
profiles and therapeutic approaches over a decade
Abstract
Central apneas are a prevalent yet complex phenomenon, particularly
among children. This retrospective study, conducted over a decade (from
2012 to 2022), analyzed central apneas in a cohort of 612 pediatric
patients who underwent ventilation at the Sleep Medicine and Long-Term
Ventilation Unit of the Bambino Gesù Children’s Hospital in Rome, Italy.
Among this group, 67 patients met the inclusion criteria for central
apneas. Central apneas often arise within the context of various
underlying pathologies, including neurological disorders, genetic
syndromes, and brain tumors. We categorized patients into three main
groups including patients with “exclusively central apneas”,
“predominantly central apneas”, and “predominantly obstructive
apneas”. Ventilation modes were diverse, with pressure-controlled
ventilation and pressure support being commonly used, reflecting the
individualized nature of therapy. The choice of ventilation mode has
been influenced by the underlying diagnosis and the severity of central
apneas, with pressure support ventilation being the most frequently
employed mode. Continuous Positive Airway Pressure was also employed in
select cases. A statistically significant reduction (p<0.05)
in mean cAHI was observed in patients with multimalformation syndromes,
hypoxic-ischemic encephalopathy and Prader-Willi Syndrome. The reduction
in mean cAHI was not statistically significant in the case of patients
with brain tumors. While non-invasive ventilation was commonly used,
invasive mechanical ventilation was selectively employed in more severe
cases. The study highlights the need for personalized therapeutic
strategies when managing central apneas in pediatric patients.