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 (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. P(PSG) median (interquartile range) was 8 (7-11) cmH₂O, mean autoCPAP-derived pressure (P(MEAN)) was 6.2 (5.6-7.6) cmH₂O, peak mean pressure (P(PEAKMEAN)) was 9.4 (7.7-11.1) cmH₂O, and average device pressure ≤ 90% of the time (P(90)) was 8.1 (7.2-9.7) cmH₂O. 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 P(PSG) (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.