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Lessons learned in outpatient initiation and prescription of paediatric APAP

Lauren C Nisbet1, Rebecca Mihai2, Nicole C Verginis2

  • 1Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia.

Sleep Medicine
|May 19, 2026
PubMed

Insights

Adjusting auto-titrating positive airway pressure (APAP) in children with obstructive sleep apnea early in treatment correlates with better adherence. Titration polysomnography remains crucial for optimizing APAP settings in many pediatric patients.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Biomedical Engineering

Background:

  • Auto-titrating positive airway pressure (APAP) is a common treatment for pediatric obstructive sleep apnea (OSA).
  • Remote data monitoring is frequently used to guide initial APAP pressure settings.
  • Understanding early treatment dynamics is key to optimizing adherence and outcomes.

Purpose of the Study:

  • To analyze initial APAP prescriptions and necessary adjustments in children over the first four weeks of treatment.
  • To compare adherence rates between children requiring APAP pressure adjustments and those who did not.
  • To evaluate the impact of titration polysomnography on subsequent APAP prescription changes.

Main Methods:

  • A retrospective review of 143 children treated with APAP between 2020 and 2025 was conducted.
  • Data collected included initial APAP settings, changes within the first four weeks, and adherence metrics.
  • The study also analyzed pressure recommendations following titration polysomnography.

Main Results:

  • 41% of children required at least one APAP pressure adjustment in the initial four weeks.
  • Children needing pressure changes demonstrated significantly better adherence (93% vs. 57% nights used).
  • 60% of children undergoing titration polysomnography had their APAP prescription changed, irrespective of early treatment adjustments.

Conclusions:

  • Early APAP prescription adjustments in pediatric OSA patients are associated with improved adherence, though causality is uncertain.
  • Titration polysomnography continues to be essential for refining APAP settings in a significant portion of children.
  • The findings underscore the need for individualized titration strategies in pediatric APAP therapy.
Abstract

Keywords:
Obstructive sleep apnoeaPaediatricPolysomnographyPositive airway pressureTitration

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