0730 AutoCPAP For The Treatment Of Obstructive Sleep Apnea In Children

In-laboratory titration polysomnography (PSG) is standard to determine optimal therapeutic continuous positive airway pressure (CPAP) in children with obstructive sleep apnea syndrome (OSAS) treated with CPAP. Use of auto titrating CPAP devices (autoCPAP) as an alternative is not well studied in children. We hypothesized that autoCPAP-derived pressures (P_AUTO) correlate with the gold standard of titration PSG pressure (P_PSG).

Retrospective study of children cared for in a pediatric sleep center initiated on autoCPAP between 2007 and 2017 who had a titration PSG. Children who used autoCPAP ≥ 120 minutes on the nights used within 90 days of titration PSG and whose residual obstructive apnea hypopnea index (OAHI) decreased by ≥ 75% were included in the analysis. P_AUTO were obtained from usage downloads and compared to P_PSG. P_PSG predictive factors were analyzed by median regression. Non-parametric methods were used for analysis.

110 children were initiated on autoCPAP and 44 satisfied inclusion criteria. Age (mean±SD) was 12.9±4.0 years, 63.6% were obese (BMI ≥ 95%). P_PSG median[IQR] was 8[7-11] cmH₂O, P_AUTO mean pressure (P_MEAN) 6.2[5.6-7.6] cmH₂O, peak mean pressure (P_PEAKMEAN) 9.4[7.7-11.1] cmH₂O, and average device pressure < 90% of the time (P₉₀) 8.1[7.2-9.7] cmH₂O. All three P_AUTO correlated with P_PSG (rho 0.34, 0.36, 0.33, respectively; p <0.05). P_MEAN was significantly lower than the other three pressures (p<0.0002). Median regression analysis demonstrated that after adjusting for patient characteristics such as age, BMI, obesity status, baseline OAHI, race and gender, P_AUTO remained significant predictors of P_PSG (p<0.05). There were no significant interactions between these patient characteristics and P_AUTO.

AutoCPAP can be effectively used in children. P_PEAKMEAN and P₉₀ are in better agreement with P_PSG. P_MEAN was lower than P_PSG underscoring that autoCPAP decreases pressure when less pressure is needed. Long-term studies of autoCPAP for the treatment of OSAS in children are needed to determine its impact on adherence and health outcomes in children.

T32HL07713, K01HL130719