Auto-titrating CPAP for the treatment of obstructive sleep apnea in children

Ilya Khaytin*, Ignacio E. Tapia, Melissa S. Xanthopoulos, Christopher Cielo, Ji Young Kim, Julianne Smith, Edward C. Matthews, Suzanne E. Beck

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)871-878
Number of pages8
JournalJournal of Clinical Sleep Medicine
Volume16
Issue number6
DOIs
StatePublished - Jun 15 2020
Externally publishedYes

Keywords

  • Auto-titrating CPAP
  • Children
  • Continuous positive airway pressure
  • Device pressure
  • Obstructive sleep apnea
  • Pediatrics
  • Titration polysomnography treatment pressure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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