Long-term non-invasive ventilation in children with central nervous system disorders: A systematic review and meta-analysis

Dalal A Alzaid; Florence Birru; Mohammed M AlBalawi; Bashar Alkhaledi; Prabhjot K Bedi; Summer Hudson; Tamer Abusido; Maria L Castro-Codesal; Deborah Olmstead; Joanna E MacLean

doi:10.1016/j.prrv.2026.02.001

Long-term non-invasive ventilation in children with central nervous system disorders: A systematic review and meta-analysis

Paediatr Respir Rev. 2026 Feb 5:S1526-0542(26)00017-5. doi: 10.1016/j.prrv.2026.02.001. Online ahead of print.

Authors

Affiliations

¹ Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Respiratory Care Program, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
² Division of Respiratory Medicine, Department of Pediatrics, IWK Health Centre, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
³ King Faisal Specialist Hospital and Research Center, Lung Health Center, Organ Transplant Center of Excellence, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.
⁴ Pediatric Pulmonary and Sleep Unit, Al-Sabah Hospital, Kuwait.
⁵ Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada.
⁶ Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
⁷ Department of Pediatrics, Ministry of National Guard Health Affairs, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
⁸ Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; Stollery Children's Hospital, Edmonton, Alberta, Canada.
⁹ Stollery Children's Hospital, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
¹⁰ Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada. Electronic address: maclean5@ualberta.ca.

PMID: 41708415
DOI: 10.1016/j.prrv.2026.02.001

Abstract

Background: Long-term non-invasive ventilation (LT-NIV) is commonly used to treat sleep-related breathing disorders (SRBD) in children. Children with central nervous system (CNS) disorders experience a high rate of SRBDs. However, the outcomes of LT-NIV use for children with CNS disorders remains unclear.

Methods: This systematic review is a sub-study of a scoping review on LT-NIV use in children. The scoping review search strategy identified studies of children using LT-NIV from January 1990 to March 2024. These results were searched for studies of children with CNS disorders. To identify studies for meta-analysis, studies were grouped as: 1) studies of children with CNS disorders as part of broader a broader group of children using LT-NIV; 2) studies exclusively of children with CNS disorders using LT-NIV; and 3) studies of children with congenital central hypoventilation syndrome using LT-NIV. The Non-Randomized Studies of Interventions tool was used to assessed risk of bias.

Results: A total of 55 studies met inclusion criteria and included 2,015 children with CNS disorders using LT-NIV. Nineteen studies reported outcomes specific to children with CNS disorders. Meta-analysis of four studies showed no difference in mortality between children with and without CNS disorders(1.23, 95% CI: 0.40-3.79). Hospitalization rates across four studies suggested a higher rate of hospitalization in children with CNS disorders compared to children without CNS disorders. Meta-analysis of three studies showed reductions in the apnoea-hypopnoea index following LT-NIV use; the response to LT-NIV, however, varied across individual studies.

Conclusion: LT-NIV use may benefit some children with CNS disorders, particularly through improvements in sleep-related breathing disorders. However, data remain limited, and uncertainty persists regarding the impact on mortality, hospitalization, and other important outcomes.

Keywords: Congenital central hypoventilation syndrome; Mechanical ventilation; Mortality; Paediatrics; Quality of life.

Publication types

Review