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.

Objectives/background: Sleep laboratory polysomnography (PSG) is the gold standard for obstructive sleep apnea (OSA) diagnosis in infants, but its access remains limited. Another simple and widely used tool, oximetry-capnography can provide information on the presence of desaturations and alveolar hypoventilation. However, its reliability is debated. This study aimed at examining its use in determining OSA severity in infants. Patients/methods: This retrospective study was conducted in a sleep unit in a tertiary hospital, in infants < 4 months old with clinical signs of OSA or Pierre Robin Sequence (PRS) who underwent a one-night PSG coupled with oximetry-capnography. Results: Among the 78 infants included (median [IQR] age: 61 [45-89] days at PSG), 44 presented with PRS, and 34 presented with isolated airway obstruction. The clinical, sleep and respiratory characteristics were not significantly different between the two subgroups. In the entire cohort, 63.5% had severe OSA. Median OAHI was 14.5/h [7.4-5.9], Spo2 was 97.4% [96.5-98.1], and PtCO2 was 41.1 mmHg [38.3-44.9]. The optimal threshold to predict OAHI > 10/h was 6/h for OD3% (sensitivity 95.7%, specificity 51.9%) and 2/h for OD4% (sensitivity 95.7%, specificity 48.1%). Conclusion: Whereas transcutaneous capnography does not appear to be sufficient in predicting severe OSA in infants < 4 months old with PRS or clinical signs of OSA, oximetry may be a useful alternative for the screening of severe OSA in infants in the absence of PSG.

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.

Asthma assessment by spirometry is challenging in children as forced expiratory volume in one second (FEV1) is frequently normal at baseline. Bronchodilator (BD) reversibility testing may reinforce asthma diagnosis but FEV1 sensitivity in children is controversial. Ventilation inhomogeneity, an early sign of airway obstruction, is described by the upward concavity of the descending limb of the forced expiratory flow-volume loop (FVL)s, not detected by FEV1. The aim was to test the diagnosis ability of FVL shape indexes as β-angle and forced expiratory flow at 50% of the forced vital capacity (FEF50)/peak expiratory flow (PEF) ratio, to identify asthmatics from healthy children in comparison to “usual” spirometric parameters. Seventy-two asthmatic children and twenty-nine controls aged 8 to 11 years were prospectively included. Children performed forced spirometry at baseline and after BD inhalation. Parameters were expressed at baseline as z-scores and BD reversibility as percentage of change reported to baseline value (Δ%). Receiver operating characteristic curves were generated and sensitivity and specificity at respective thresholds reported. Asthmatics presented significantly smaller zβ-angle, zFEF50/PEF and zFEV1 (p≤0.04) and higher BD reversibility, significant for Δ%FEF50/PEF (p=0.02) with no difference for Δ%FEV1. zβ-angle and zFEF50/PEF exhibited better sensitivity (0.58, respectively 0.60) than zFEV1 (0.50), and similar specificity (0.72). Δ%β-angle showed higher sensitivity compared to Δ%FEV1 (0.72 vs 0.42), but low specificity (0.52 vs 0.86). Quantitative and qualitative assessment of FVL by adding shape indexes to spirometry interpretation may improve the ability to detect an airway obstruction, FEV1 reflecting more proximal while shape indexes peripheral bronchial obstruction.