Auto-titrating CPAP for the treatment of obstructive sleep apnea in children

Abstract

Study objectives: In-laboratory titration polysomnography (PSG) is standard to determine optimal therapeutic continuous positive airway pressure (CPAP) in children with obstructive sleep apnea (OSA). The use of auto-titrating CPAP devices (autoCPAP) as an alternative to CPAP titration has not been well studied in children. We hypothesized that autoCPAP-derived pressures (P_MEAN, P_PEAKMEAN, P₉₀) would be similar to titration PSG pressure (P_PSG).

Methods: This is a retrospective study of children with OSAS initiated on autoCPAP between 2007 and 2017, who used autoCPAP for at least 2 h/night and who had adequate titration PSG were included in the analysis. AutoCPAP-derived pressures were obtained from use downloads and compared with P_PSG. P_PSG predictive factors were analyzed by median regression. Nonparametric methods were used for analysis.

Results: Of 110 children initiated on autoCPAP, 44 satisfied the inclusion criteria. Age (median (interquartile range)) was 13.01 (9.98-16.72) years, and 63.6% were obese. P_PSG median (interquartile range) was 8 (7-11) cmH₂O, mean autoCPAP-derived pressure (P_MEAN) was 6.2 (5.6-7.6) cmH₂O, peak mean pressure (P_PEAKMEAN) was 9.4 (7.7-11.1) cmH₂O, and average device pressure ≤ 90% of the time (P₉₀) was 8.1 (7.2-9.7) cmH₂O. AutoCPAP-derived pressures correlated with P_PSG (P < .05). P_MEAN was lower than the other 3 pressures (P < .0002). Median regression analysis demonstrated that after adjusting for patient characteristics such as age, sex, and obesity status, autoCPAP-derived pressures remained significant predictors of P_PSG (P < .05). There were no significant interactions between these patient characteristics and autoCPAP-derived pressures.

Conclusions: This study demonstrates that autoCPAP-derived pressures correlate with the titration PSG-derived pressures. These results indicate that autoCPAP can be used in the pediatric population and can determine pressures that are close to the titration pressures.

Keywords: auto-titrating CPAP; children; continuous positive airway pressure; device pressure; obstructive sleep apnea; pediatrics; titration polysomnography; treatment pressure.