APAP vs. Fixed-Pressure CPAP in Peds With OSA

SEATTLE, WA—In children with obstructive sleep apnea (OSA), pressure delivered by auto-adjusting CPAP (APAP) is significantly lower than that determined to be the optimal pressure derived from CPAP titration polysomnogram (PSG), results of a study presented at SLEEP 2015 have found.

In addition, “treatment with APAP does not convey added benefit to adherence compared to CPAP,” noted Justin Brockbank, MD, of Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

Although in-lab CPAP titration PSG is the accepted method for determining appropriate therapeutic pressure setting for children and APAP is commonly used in adults, only limited data are available on the use of APAP in children.

The prospective, double-blind, randomized crossover study of children and adolescents had two hypotheses: “In children, APAP can effectively deliver the appropriate pressure as determined by CPAP titration PSG,” and “APAP conveys better patient comfort, adherence, and objective measures of symptom control than fixed CPAP in the pediatric population.”

To test these hypotheses, Dr. Brockbank and colleague enrolled 22 subjects. Mean age was 14.3 years and mean O-AHI on diagnostic PSG, 12.7. Excluded were those with prior CPAP use, craniofacial abnormalities, and neurological or neuromuscular disease.

All subjects began therapy with APAP for 6–8 weeks, with CPAP titration PSG at six weeks. Subjects were then randomized to fixed CPCP or APAP for four weeks and crossed over to the alternate arm for four weeks. Subjects completed the Michigan Pediatric Sleep Questionnaire (PSQ), the Epworth Sleepiness Scale (ESS), the Pediatric Quality of Life Inventory (PedsQL) and the CPAP Follow-up Questionnaire at each visit.

Eight subjects completed the full protocol, and 15 were included for pressure comparison. Of the seven who withdrew, two failed to follow protocol, four were lost to follow-up, and one was nonadherent.

PSQ scores improved significantly from baseline to both APAP and CPAP periods (P<0.05); however, there no significant differences in post-treatment ESS, PedsQL, or CPAP-Follow-Up Questionnaire scores.

Dr. Brockbank noted that study limitations include small sample size, small number of pre-adolescent subjects, and that it was a short-term study.