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

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 (P-MEAN, P-PEAKMEAN, P-90) would be similar to titration PSG pressure (P-PSG). 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 P-PSG. P-PSG 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) cmH(2)O, mean autoCPAP-derived pressure (PMEAN) was 6.2 (5.6-7.6) cmH(2)O, peak mean pressure (P-PEAKMEAN) was 9.4 (7.7-11.1) cmH(2)O, and average device pressure <= 90% of the time (P-90) was 8.1 (7.2-9.7) cmH(2)O. AutoCPAP-derived pressures correlated with P-PSG (P <.05). P-MEAN 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.