Clinical Note
June 2013

An Adverse Effect of Positive Airway Pressure on the Upper Airway Documented With Magnetic Resonance Imaging

Author Affiliations

Author Affiliations: Departments of Radiology (Dr Fleck), Anesthesiology (Dr Mahmoud), Pulmonary Medicine (Mr McConnell and Dr Amin), and Otolaryngology–Head and Neck Surgery (Dr Shott), University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati (Dr Gutmark).

JAMA Otolaryngol Head Neck Surg. 2013;139(6):636-638. doi:10.1001/jamaoto.2013.3279

Importance Positive pressure air is used during basic life support to provide respirations and applied as continuous positive airway pressure to maintain a patent airway during sleep or anesthesia. These functions are more critical in children with obstructive sleep apnea, who often have smaller airway dimensions and increased airway collapsibility.

Observations We report 2 cases of boys with Down syndrome and a history of obstructive sleep apnea in whom adverse narrowing of the retroglossal airway is caused by continuous positive airway pressure applied via face mask as documented with magnetic resonance imaging.

Conclusions and Relevance Administration of continuous positive airway pressure by means of face mask to patients can result in adverse effects on the airway patency by pushing the tongue posteriorly. Awareness of this effect on patients with open mouths and large tongues, as present in Down syndrome, is important for sleep apnea treatment, anesthesia, and emergency respiratory support. Generalization of our observation is not possible at this time. Additional prospective studies of the effects of continuous positive airway pressure on airway patency in sedated and/or anesthetized children are required to confirm our anecdotal observations.