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Auto-titrating CPAP for the treatment of obstructive sleep apnea in children
Ilya Khaytin1, Ignacio E Tapia1,2, Melissa S Xanthopoulos1
1Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Auto-titrating CPAP (autoCPAP) devices can determine effective positive airway pressure (PAP) for children with obstructive sleep apnea (OSA), correlating well with traditional polysomnography (PSG) titration. This suggests autoCPAP is a viable alternative for pediatric OSA management.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Medical Device Technology
Background:
- In-laboratory polysomnography (PSG) with continuous positive airway pressure (CPAP) titration is the standard for managing pediatric obstructive sleep apnea (OSA).
- The efficacy of auto-titrating CPAP (autoCPAP) devices in children has not been extensively studied.
- This research investigates autoCPAP as a potential alternative to traditional CPAP titration in pediatric OSA patients.
Purpose of the Study:
- To compare autoCPAP-derived pressures with in-laboratory titration PSG pressures in children with OSA.
- To determine if autoCPAP can accurately predict optimal therapeutic CPAP levels.
- To evaluate the feasibility of using autoCPAP for pressure determination in pediatric OSA.
Main Methods:
- Retrospective analysis of 110 children with OSA initiated on autoCPAP between 2007 and 2017.
- Inclusion criteria: autoCPAP use ≥ 2 h/night and adequate titration PSG data.
- Comparison of autoCPAP pressures (PMEAN, PPEAKMEAN, P90) with titration PSG pressure (PPSG) using nonparametric methods and median regression.
Main Results:
- 44 children met inclusion criteria; median age 13 years, 63.6% obese.
- AutoCPAP-derived pressures (PMEAN, PPEAKMEAN, P90) showed significant correlation with PPSG (P < .05).
- Median regression confirmed autoCPAP pressures as significant predictors of PPSG after adjusting for patient characteristics.
Conclusions:
- AutoCPAP-derived pressures correlate well with titration PSG pressures in children with OSA.
- AutoCPAP devices are a viable option for determining therapeutic CPAP pressures in the pediatric population.
- These findings support the use of autoCPAP as an alternative to traditional titration PSG for pediatric OSA management.
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 (PMEAN, PPEAKMEAN, P90) would be similar to titration PSG pressure (PPSG).
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 PPSG. PPSG 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. PPSG median (interquartile range) was 8 (7-11) cmH₂O, mean autoCPAP-derived pressure (PMEAN) was 6.2 (5.6-7.6) cmH₂O, peak mean pressure (PPEAKMEAN) 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 PPSG (P < .05). PMEAN 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 PPSG (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.
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