Autoset continuous positive airway pressure (APAP) therapy: Argument for use in children

Abstract

Introduction: The prevalence of paediatric obstructive sleep apnoea (OSA) is 3%. The commonest causes include adenotonsillar hypertrophy, obesity, hypotonia, & craniofacial anomalies. Continuous positive airway pressure (CPAP) is well recognised as a treatment for OSA in adult and paediatric practice. In adult patients, Autoset CPAP (APAP) is increasingly being used over fixed pressure CPAP with advantages including cost benefit, avoidance of repeat PSG lab studies & elimination of the potential bias of in-lab versus home study. APAP accounts for fluctuation in an individual's pressure requirements over time due to variability in weight, change in underlying medical conditions, or resolution of upper airway edema. Multiple studies describe the use of APAP in adults but evidence for use of APAP in children is limited. Extrapolating from adult experience suggests that similar benefits may be achieved in paediatric patients, justifying a role in children. Methods: We conducted a retrospective review of the patients from our centre over a 5 yr period in whom APAP has been used for treatment of OSA. Results: We identified 7 children using APAP therapy for ongoing treatment (group1) &13 patients where APAP was used for initial titration before being established on fixed CPAP pressure (group2). In group 1, 1 patient was changed from CPAP to APAP due to experiencing side effects from a fixed high pressure & another was established on APAP at home due to underlying behavioural difficulties & inability to undertake lab titration. The average age of patients in whom on-going home APAP therapy was established was 13.4 years & the mean weight was 55.96 (BMI = 21.79). The mean OAHI on diagnostic study was 8.58/hr (n = 5) and mean arousal index was 6.27/hr(n = 5). In group 2, mean age, weight & BMI was 13.9, 93.24, 33.78(n = 11) respectively. The mean diagnostic OAHI was 29.1/hr & arousal index was 13.9/hr (n = 11) respectively. Discussion: APAP was successfully utilised in 20 patients over a 5 yr period. 2 different approaches were used; one to aid determination of fixed pressure & the other to sustain on-going therapy. APAP could potentially have a similar role in paediatric practice to that in adults, reducing the need for lab titration studies and benefiting those patients who have fluctuating pressure requirements. Prospective research is planned to evaluate this further.L720721582015-11-20 <br />