Effects of overnight supplemental oxygen in obstructive sleep apnea in children

Supplemental oxygen during sleep may be useful as a temporary palliative treatment in children with obstructive sleep apnea syndrome (OSAS) associated with significant hypoxemia. However, supplemental O-2 may also blunt hypoxic ventilatory drive and worsen ventilation. To assess the safety of the use of supplemental O-2 in children with OSAS, we studied 16 children ages 2-8 (mean: 4.28 +/- 2.88 yr) with OSAS secondary to adenotonsillar hypertrophy. Patients underwent two overnight polysomnograms within 1 mo, one on room air (RA) and one while receiving supplemental O-2 via nasal cannula titrated by 1/4 Ipm increments to achieve SpO(2) > 95% during the first hour of sleep. Oxygenation measurements were significantly improved during supplemental O-2 nights (average SpO(2) increased from 89.5 +/- 4.8% on RA to 97.7 +/- 1.8% on supplemental O-2 [p < 0.00001]) while alveolar ventilation remained unchanged (PET(CO2) > 50 mm Hg: 3.6 +/- 8.9% total sleep time on RA and 3.3 +/- 6.3% total sleep time on supplemental O-2 [p = NS]). Supplemental O-2 significantly reduced hypopnea density, obstructive apnea index, and paradoxical breathing. The density and average duration of central apneas remained unchanged. in addition, supplemental O-2 increased the percentage of REM sleep time and decreased the number of microarousals. We conclude that supplemental O-2 might be a safe and beneficial temporary treatment in children with OSAS.