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

• Published in: Journal of clinical sleep medicine Vol. 16; no. 6; pp. 871 - 878
• Main Authors: Khaytin, Ilya, Tapia, Ignacio E, Xanthopoulos, Melissa S, Cielo, Christopher, Kim, Ji Young, Smith, Julianne, Matthews, Edward C, Beck, Suzanne E
• Format: Journal Article
• Language: English
• Published: United States American Academy of Sleep Medicine 15.06.2020
• Subjects: Scientific Investigations; obstructive sleep apnea; device pressure; auto-titrating CPAP; children; pediatrics; treatment pressure; continuous positive airway pressure; titration polysomnography
• ISSN: 1550-9389; 1550-9397; 1550-9397
• DOI: 10.5664/jcsm.8348

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 , P , P ) would be similar to titration PSG pressure (P ). 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 . P predictive factors were analyzed by median regression. Nonparametric methods were used for analysis. 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 median (interquartile range) was 8 (7-11) cmH₂O, mean autoCPAP-derived pressure (P ) was 6.2 (5.6-7.6) cmH₂O, peak mean pressure (P ) was 9.4 (7.7-11.1) cmH₂O, and average device pressure ≤ 90% of the time (P ) was 8.1 (7.2-9.7) cmH₂O. AutoCPAP-derived pressures correlated with P (P < .05). P 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 (P < .05). There were no significant interactions between these patient characteristics and autoCPAP-derived pressures. 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.