Autotitrating CPAP as a Tool for CPAP Initiation for Children

Abstract

Study Objectives: Few studies have assessed autotitrating positive airway pressure (autoPAP) for treatment of obstructive sleep apnea (OSA) in children. We aimed to review our use of autoPAP for initiation of continuous positive airway pressure (CPAP) therapy in children, and compare autoPAP-derived treatment pressures to CPAP treatment pressure determined by attended polysomnography (PSG). Methods: Retrospective review of children initiated on autoPAP from 2013 to 2015. Mean autoPAP pressure (AutoMean pressure) and average device pressure ≤ 90% of time (Auto90 pressure) were taken from downloaded data and compared to the recommended treatment pressure following titration PSG (PSG pressure). Results: Fifty-two children started CPAP, of whom 26 (age ± standard deviation 11.9 ± 3.4 years) used autoPAP and had titration PSG. AutoPAP was used on average 84% of nights (standard deviation 20%) in the first month, with a mean ± standard deviation 6.3 ± 2.0 hours of use on nights used. The median (interquartile range) obstructive apnea-hypopnea index decreased from 16.6 (11, 35) events/h before treatment to 2.2 (0.4, 3.8) events/h on the titration PSG. Median (interquartile range) PSG pressure was 9.0 cm H2O (7.0, 10.0), AutoMean pressure was 6.3 cm H2O (5.3, 7.5), and Auto90 pressure was 8.1 cm H2O (7.1, 9.5). These were significantly different (P < .001), with the significant difference lying between AutoMean and the other two pressures. PSG pressure was greater than or equal to the AutoMean pressure in all cases, and greater than or equal to the Auto90 pressure in 20 out of 26 cases (77%). Conclusions: AutoPAP is a safe and effective means of initiating CPAP in children. AutoMean and Auto90 pressures are usually below treatment pressure determined by titration PSG.

Can Auto-CPAP Determine Therapeutic CPAP Pressure in Children with OSA?

“…However the pressure difference falling within 2 cm H 2 O were noted only in 69% of cases. The magnitude of difference ranged from 8 cm H 2 O under PSG pressure to 3 cm H 2 O over PSG pressure [7]. The results of Mihai's study were compatible with our current study.…”

“…The youngest age of our adherence patients was found to be 4 years with the body weight of 12.6 Kg. This indirect evidence confirmed the usefulness of auto-CPAP in children with OSA as reported by Palombini et al, Marshall et al and Mihai et al Unfortunately we did not collect data of the polysomnographic parameters, oxygen saturation or the quality of life that might be improved after auto-CPAP therapy [5][6][7].…”

“…In 2017, Mihai et al conducted a retrospective study in children comparing these downloaded pressure data with the CPAP pressure determined by PSG. They found that downloaded pressure from auto-CPAP report were usually below treatment pressure determined under PSG [7]. Since this study was a retrospective review and recruited CPAP-naïve children whose parents reported CPAP use of at least 1 to 2 hours a night, 39% of the children were found to be non-adherence as using auto-CPAP less than 90% of the time.…”

Outpatient initiation of long‐term continuous positive airway pressure in children

“…Outpatient CPAP initiation programs have been reported in other countries, namely in the USA and in Autralia . The main difference between these outpatient programs and our program is the complete absence of the need for an in‐hospital titration PSG.…”

“…The decision on the setting where to start CPAP varies largely according to local practice. Outpatient programs that involve home acclimation to the interface and the device, followed by an in‐hospital titration PSG have been developed in the USA and in Australia . Some experience has been reported on the initiation of mechanical ventilation in an outpatient or home setting in adult patients, but experience in children is scarce .…”