Automatic positive airway pressure (APAP) may reduce wait times for treatment of OSA in paediatric practice

Abstract

Introduction: Obstructive sleep apnoea (OSA) in children is associated adverse health outcomes including deficits in cognition, behaviour, growth and cardiovascular function. The most common cause of OSA in children is adenotonsillar hypertrophy and surgery is 1st line treatment. However, residual OSA is often present despite adenotonsillectomy, particularly in those with comorbid conditions such as obesity or congenital syndromes. For these children CPAP (continuous positive airway pressure) is often utilised. Automatic positive airway pressure (APAP) devices deliver varying pressures according to a patient's needs. Adult studies show equivalence of APAP to CPAP for OSA treatment but also suggest additional benefits such as enabling earlier treatment and improved adherence. Paediatric sleep resources are limited, with significant wait time to access specialist services and initiate definitive treatment. More evidence around the efficacy of APAP in children is needed in order to develop alternative models of care that may facilitate earlier access to treatment for patients. Methods: A retrospective review of all patients from our centre in whom APAP was used to initiate therapy in our lab was undertaken. Data was collected over a 2-year period. Results: There were 37 patients (4-17 yrs) in whom APAP was used for titration (14 Female; 23 Males). Patients waited an average of 9.6 weeks from diagnostic study to in-lab titration (0-35.6 weeks). Average OAHI reduced from 31/hr (0.3-126.1 hr) to OAHI 1.36/hr (0- 6-6.7) in patients who tolerated therapy (n = 30). Mean maximum TcCO2 reduced from 52.2 mmHg to 48.7 mmHg with APAP. Three patients failed trial due to intolerance of mask; two were never established on CPAP/APAP and one required alternative management for catathrenia. Two patients changed to VPAP due to complex OSA. A further 2 patients required manual titration but both failed to use CPAP/APAP at home. Discussion: APAP showed a significant improvement in OAHI in all patients who tolerated therapy (81%). With appropriate family education, initiating APAP at home while awaiting a titration study could be a feasible model of care for treatment of OSA with the benefit of treating patients earlier. This approach may also have a cost benefit by leading to fewer lab studies and shorter inpatient stays to initiate treatment.L6195254062017-12-08 <br />