소아 폐쇄성 수면 무호흡에서 지속기도양압기 치료
CPAP Treatment in Pediatric Obstructive Sleep Apnea
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초록
소아 OSA 환자에서 여러가지 치료 장벽으로 CPAP의 순 응도는 낮다. 어린 소아나 발달지연이 있는 소아에서는 기계 와 마스크에 대한 거부감을 극복하기 위한 탈감작과정이 필 요하다. 성인과 달리 성장하고 있는 소아에서는 마스크를 자 주 교체해주어야 하며, 증상의 변화나 압력 요구량의 변화에 대해 잘 관찰하고 필요시 압력적정검사를 추적해야 한다. 기 도양압기를 사용하는 가족과 환자에 대한 적극적인 지원과 관리는 치료 순응도를 높이는데 중요하다. 연구가 더 필요하 지만, 소아에서도 autoPAP은 안전하게 시작될 수 있는 치료 이며, CPAP을 못하거나 순응도가 낮은 경우에 HFNC를 대체치료로 고려해 볼 수 있다.
Abstract
Adenotonsillar hypertrophy is the most common cause of pediatric obstructive sleep apnea (OSA) in children, and therefore, ad¬enotonsillectomy is the first-line therapy in most pediatric patients. In cases of residual OSA after adenotonsillectomy, and in cases where surgical intervention is not feasible, positive airway pressure (PAP) therapy is often employed. Those conditions in¬clude obesity, craniofacial malformation, Down syndrome, and neuromuscular disorders. In this article, continuous positive air¬way pressure (CPAP) preparation, titrations, barriers to effective CPAP therapy, monitoring, and adherence to CPAP in children will be described.
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