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.