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Efficacy and adherence of non-invasive ventilation treatment in children with Down syndrome
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  • Lauren MacDonagh,
  • Lisa Farrell,
  • Ruth O'Reilly,
  • Paul McNally,
  • Sheila Javadpour,
  • Des Cox
Lauren MacDonagh
University College Dublin School of Medicine
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Lisa Farrell
Our Lady's Children's Hospital, Crumlin
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Ruth O'Reilly
Our Lady's Children's Hospital, Crumlin
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Paul McNally
Our Lady's Children's Hospital
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Sheila Javadpour
Our Lady's Children's Hospital Crumlin
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Des Cox
Our Lady's Children's Hospital, Crumlin
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Abstract

Objective: Children with Down syndrome (DS) have an increased prevalence of obstructive sleep apnoea (OSA). Non-invasive ventilation (NIV) is a common modality of OSA treatment in this cohort. This study aimed to measure adherence and efficiency of NIV delivery in children with DS. Study design: This was a retrospective cohort study involving 106 children with confirmed OSA and home NIV with downloadable data capacity. Children were divided into DS (n=44) and non-DS cohorts (n=62). Adherence, clinical outcomes apnoea-hypopnoea index (AHI), positive airway pressure delivery and leakage were recorded and compared between DS and non-DS cohorts and within the DS cohort based on past surgical history. Results: Significantly greater NIV usage was observed in the DS cohort, they showed more consistent use with an increased percentage of days used relative to their non-DS counterparts (78.95 ± 2.26 versus 72.11 ± 2.14, p=0.031). However, despite greater usage, poorer clinical outcomes in the form of increased AHI (p=0.0493) was observed in the DS cohort, where significantly greater leakage was also shown 41.00 ± 1.61L/min versus 36.52 ± 1.18L/min (p=0.022). Twenty children with DS had prior cardiac surgery; compliance across all parameters was significantly reduced relative to those without. Conclusions: These data confirm that satisfactory NIV adherence is achievable in children with DS. However, we have identified excessive system leak at the machine-patient interface as a factor, which could undermine NIV efficacy in children with DS.

Peer review status:ACCEPTED

27 Sep 2020Submitted to Pediatric Pulmonology
28 Sep 2020Submission Checks Completed
28 Sep 2020Assigned to Editor
28 Sep 2020Reviewer(s) Assigned
30 Sep 2020Review(s) Completed, Editorial Evaluation Pending
03 Oct 2020Editorial Decision: Revise Major
01 Jan 20211st Revision Received
04 Jan 2021Submission Checks Completed
04 Jan 2021Assigned to Editor
04 Jan 2021Reviewer(s) Assigned
12 Jan 2021Review(s) Completed, Editorial Evaluation Pending
20 Jan 2021Editorial Decision: Accept