Sleep studies in children on long-term non-invasive respiratory support

The aim of this study was to assess the impact of changes in respiratory support (RS) settings recommended after a titration polysomnography (PSG), in terms of daytime symptoms and quality of life. A retrospective chart review of all RS (CPAP and bi-level ventilation) titration studies was carried out at our tertiary paediatric sleep laboratory in the past 5 years. All patients with at least two studies in the past 5 years were included in the analysis. Parents completed the obstructive sleep apnoea (OSA)-18 and Paediatric Daytime Sleepiness Scale (PDSS) questionnaires on the night of each PSG. Results are presented as means (SD). A total of 42 patients (25 on CPAP and 17 on bi-level ventilation, age 11 (6) years) had 71 pairs of titration studies (41 CPAP and 30 bi-level). Changes in RS settings were recommended in 27 of 41 (65 %) CPAP studies and 11 of 30 (36 %) bi-level studies. Overall, changes were fully implemented by the treating physician in 55 % of cases. There was an improvement in total OSA-18 score between studies in 48 % of the paired CPAP studies and 65 % of bi-level studies. OSA-18 scores improved in 47 % of the studies where any recommended change had been implemented versus 0 % of those where none of the recommended changes had been made (p = 0.1). Titration studies frequently led to recommendations for a change in RS settings in these patients on long-term RS. Symptom scores were more likely to improve if recommendations for change were implemented by the time of the follow-up study.