Can CPAP therapy for paediatric OSA ever be stopped?

Abstract

Introduction: Continuous Positive Airway Pressure (CPAP) has been increasing used in treatment of paediatric Obstructive Sleep Apnoea (OSA) not resolved by surgical airway intervention. It is unclear what proportion of children can be successfully taken off CPAP and the factors that govern this cessation. Exploring this area can help predict outcomes and clarify patient concerns, as well as potentially increase understanding of the natural course of treatment resistant paediatric OSA. Aims: To describe the clinical, demographic and polysomnographic (PSG) characteristics of a cohort of children on CPAP for OSA, who could be successfully weaned off CPAP therapy. Methods: From a cohort of children on CPAP for OSA at the Lady Cilento Children's Hospital between January 2016 and December 2017, a sub-group of children who were taken off CPAP were selected. Those who were transitioned to adults, changed to bilevel support or stopped due to non-adherence were excluded from analysis. Results: CPAP therapy was stopped for 52 children over a two-year period, 26 of these were excluded from analysis due to change to bilevel support, transition to adult care or cessation due to poor adherence. 26 children [median (IQR, range) age 7.0 (1.2-12.5, 0.1-17.4) years; 20 Males] were successfully weaned off CPAP therapy based on clinical judgement and PSG data analysis; and were included in the final analysis. These children had a median (IQR) AHI of 8.2 (5.1-46.5) at CPAP initiation, and after a median (IQR) duration of 1(0.4-2.2) year, had improvement in median AHI to 3.3 (2-5.2) at CPAP cessation. The reasons for CPAP cessation included improvement post airway surgery in 7 (27%); weight loss in 2 (8%) and improved symptoms and/or PSG parameters with time in 10 (36%). In 7 children, CPAP therapy was ceased after initial trial due to poor tolerance and low physician perceived clinical benefit. Conclusion: The natural course of paediatric OSA is unclear, especially in the severe and treatment resistant cases. This is the first study describing the characteristics of children successfully weaned off CPAP therapy. Children on CPAP should be regularly screened for ongoing symptoms and need for pressure support checked since a small proportion can be successfully weaned off CPAP.L6246120222018-11-01 <br />