Child sleeping peacefully with a non-invasive ventilation mask.

Sleep Apnea Breakthrough: How Non-Invasive Support is Changing Lives

Beau Callahan in Health & Wellness November 2025 • 4 min read.

"Discover how volume-assured pressure support (VAPS) is revolutionizing sleep apnea treatment, offering new hope for those who've struggled with traditional methods."

Obstructive sleep apnea (OSA) is a prevalent condition among children, characterized by interruptions in breathing during sleep. While often manageable, severe cases can lead to life-threatening hypoxemia, where the body experiences dangerously low oxygen levels. Obesity is a significant risk factor, complicating OSA treatment and outcomes.

Continuous Positive Airway Pressure (CPAP) has been a standard intervention, delivering constant air pressure to keep airways open. However, CPAP isn't always effective, particularly in children with obesity or those who don't respond well to adenotonsillectomy—the surgical removal of the adenoids and tonsils, commonly the first line of treatment. In these challenging cases, a tracheostomy, a surgical procedure creating an opening in the neck for breathing, has often been considered.

Now, a promising alternative is emerging. This article explores a case where non-invasive ventilation (NIV) with volume-assured pressure support (VAPS) successfully treated a child with severe OSA, offering a beacon of hope and a less invasive path forward. This approach marks a significant step in pediatric sleep medicine, potentially transforming how we manage severe OSA cases.

The VAPS Advantage: A Case Study

Child sleeping peacefully with a non-invasive ventilation mask.

Consider the case of an eight-year-old boy with morbid obesity and severe OSA. His symptoms were classic: loud snoring, witnessed apneas, restless sleep, and mouth breathing. He also struggled with nocturnal enuresis, excessive daytime sleepiness, behavioral issues, and academic difficulties due to constantly falling asleep in school. His medical history included premature birth, hypertension, autism spectrum disorder, and attention-deficit/hyperactivity disorder.

Physical examination revealed a high body mass index (BMI) of 51.8 kg/m², elevated blood pressure, an obese neck, enlarged tonsils, and oropharyngeal crowding. An in-laboratory polysomnography confirmed severe OSA, with an apnea-hypopnea index (AHI) of 138.2, indicating a high frequency of interrupted breathing. The study also revealed sleep hypoventilation and hypoxemia.

Traditional treatments offered limited relief: Adenotonsillectomy wasn't a viable option due to the high risk and low probability of significant AHI reduction. CPAP therapy proved challenging, as the child couldn't tolerate the high pressures needed to maintain open airways. Tracheostomy was considered but ideally avoided due to its significant risks and impact on quality of life.

Faced with these challenges, doctors turned to a novel approach: non-invasive ventilation (NIV) using volume-assured pressure support (VAPS). This method ensures a set volume of air with each breath, adjusting pressure to meet the child's needs. The results were remarkable. A follow-up titration study showed a substantial reduction in AHI, improved oxygenation, better ventilation, and enhanced sleep quality. The child’s daytime alertness and behavior also improved significantly.

A New Era in Sleep Apnea Treatment

This case highlights the potential of VAPS as a valuable tool in treating severe pediatric OSA, particularly in children with obesity or those who haven't responded to traditional methods. While more research is needed, this innovative approach offers a promising alternative to tracheostomy, improving the lives and well-being of affected children and their families. By maintaining stable ventilation that adapts to varying respiratory mechanics, VAPS marks a significant advancement in personalized respiratory support.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1155/2018/4701736, Alternate LINK

Title: Use Of Noninvasive Ventilation With Volume-Assured Pressure Support To Avoid Tracheostomy In Severe Obstructive Sleep Apnea

Subject: General Medicine

Journal: Case Reports in Pediatrics

Publisher: Hindawi Limited

Authors: Montserrat Diaz-Abad, Amal Isaiah, Valerie E Rogers, Kevin D. Pereira, Anayansi Lasso-Pirot

Published: 2018-10-09

Everything You Need To Know

What is volume-assured pressure support (VAPS), and how does it differ from traditional sleep apnea treatments?

Volume-assured pressure support (VAPS) is a method of non-invasive ventilation that delivers a set volume of air with each breath, adjusting pressure to meet the individual's needs. This personalized approach ensures stable ventilation, adapting to varying respiratory mechanics. It's particularly useful in severe pediatric obstructive sleep apnea (OSA) cases, offering an alternative to tracheostomy when traditional methods like CPAP or adenotonsillectomy aren't effective. The advantage of VAPS is its ability to maintain consistent ventilation, leading to improved oxygenation and sleep quality.

What is obstructive sleep apnea (OSA), and why is it a concern for children, especially those with obesity?

Obstructive sleep apnea (OSA) is a condition characterized by interruptions in breathing during sleep, common among children. Severe cases can lead to life-threatening hypoxemia, marked by dangerously low oxygen levels. Obesity is a significant risk factor, complicating OSA treatment. Traditional interventions like adenotonsillectomy and CPAP aren't always effective, especially in obese children. If left untreated, severe OSA can lead to significant health issues, including cardiovascular problems, cognitive deficits, and impaired growth and development.

How does Continuous Positive Airway Pressure (CPAP) work in treating sleep apnea, and what are its limitations?

CPAP, or Continuous Positive Airway Pressure, delivers constant air pressure to keep airways open and is often the first line of treatment for obstructive sleep apnea (OSA). However, CPAP may not always be effective, particularly in children with obesity or those who don't respond well to adenotonsillectomy. In these cases, alternatives like volume-assured pressure support (VAPS) are considered. The challenge with CPAP often lies in patient tolerance and the need for high pressures, which can be uncomfortable and lead to poor adherence.

When is adenotonsillectomy considered for obstructive sleep apnea (OSA), and why might it not be a suitable option in all cases?

Adenotonsillectomy involves the surgical removal of the adenoids and tonsils and is a common initial treatment for obstructive sleep apnea (OSA), especially in children. However, it isn't always a viable option, particularly in severe cases complicated by obesity, where the probability of significant improvement in the apnea-hypopnea index (AHI) is low. When adenotonsillectomy isn't effective or feasible, alternative treatments like volume-assured pressure support (VAPS) are explored to manage OSA effectively.

What is a tracheostomy, and why is volume-assured pressure support (VAPS) being explored as an alternative for treating severe sleep apnea?

Tracheostomy is a surgical procedure that creates an opening in the neck for breathing, often considered in severe cases of obstructive sleep apnea (OSA) when other treatments have failed. While effective, it carries significant risks and impacts quality of life. Alternatives like non-invasive ventilation (NIV) with volume-assured pressure support (VAPS) are now emerging as promising options to avoid tracheostomy, offering improved outcomes and reduced invasiveness for affected children and their families. VAPS helps maintain stable ventilation, adapting to varying respiratory mechanics and improving oxygenation and sleep quality.