Initiating CPAP in an outpatient setting in children is feasible and effective in selected subjects. A high rate of compliance can be achieved as well as a correction of OSA.

Weaning from CPAP/NIV is possible in children treated with long term CPAP/NIV but is highly dependent on the underlying disorder. Spontaneous improvement is possible but most children need specific surgery. Long term follow-up is necessary in children with underlying disorders.

BACKGROUND: The aim of CPAP and noninvasive ventilation (NIV) is to correct sleepdisordered breathing and nocturnal gas exchange. The aim of the study was to analyze the results of a systematic home pulse oximetry (S pO 2 ) and transcutaneous carbon dioxide (P tcCO 2 ) monitoring in stable pediatric subjects on long-term CPAP/NIV or screened for CPAP/NIV weaning, and the consequent interventions in the subjects with abnormal gas exchange. METHODS: The home overnight S pO 2 and P tcCO 2 recordings of stable pediatric subjects treated with or weaned from CPAP, NIV, or high-flow nasal cannula between January 2017 and March 2018 were analyzed. RESULTS: A total of 110 recordings, performed in 79 subjects, median age 6 (interquartile range [IQR] 1.5-14) y, were analyzed. Fifty-two recordings (47%) were performed during NIV, 43 (39%) during CPAP, 2 (2%) during high-flow nasal cannula, and 13 (12%) during a spontaneous ventilation weaning trial from ventilatory support. The quality of recording was excellent in 81% of recordings, 5 recordings (5%) had <4 h of recording time, 5 (5%) had artifacts on the S pO 2 signal, and 16 (15%) had artifacts on the P tcCO 2 signal. Gas exchange abnormalities were observed in 11 subjects with P tcCO 2 > 50 mm Hg during 6 2% of recording time (n 5 8), mean P tcCO 2 6 50 mm Hg (n 5 6), mean P tcCO 2 < 35 mm Hg (n 5 3), and S pO 2 < 90% during 6 2% of recording time (n 5 2). Consequent interventions were (multiple interventions possible): change of device settings (n 5 6), change of interface (n 5 2), switched to high-flow nasal cannula (n 5 1), and a control recording (n 5 2). CONCLUSIONS: A significant number (12%) of systematic home S pO 2 and P tcCO 2 recordings in stable pediatric subjects treated with CPAP/NIV were abnormal and may be corrected by adequate therapeutic interventions.