Autotitrating Continuous Positive Airway Pressure Titration Compared to Laboratory-Based Polysomnography Titration for the Treatment of Obstructive Sleep Apnea in Children with Complex Chronic Care Conditions

RATIONALE Children with complex chronic conditions (CCC) are disproportionately affected by obstructive sleep apnea (OSA), and a growing number require continuous positive airway pressure (CPAP).Early initiation of effective CPAP can improve treatment adherence, so timely titration is critical.Autotitrating CPAP (APAP) can be started at home prior to the laboratory-based polysomnography (PSG) titration study, but no studies have examined its use in children with CCC.Our study aimed to compare treatment pressures determined by APAP to those determined by PSG in children with CCC.METHODS Retrospective study of children with OSA ≤18 years initiated on APAP between 2015-2019.Patients without adequate PSG or APAP data were excluded.Median pressures (P MED ) and average device pressures ≤95% of the time (P 95 ) from APAP use downloads were compared to PSG-prescribed pressures (P PSG ).Demographics, clinical characteristics, and diagnostic PSG data were also collected.Feudtner's pediatric CCC classification system version 2 was used.Institutional Research Ethics Board approval was obtained.RESULTS Fourty-eight patients met inclusion criteria.Mean age was 11.6 (SD 4.1) years, 65.3% were male, and 64.6% had a CCC.APAP was used ≥4 hours/night for a median 59.0 (31.5, 81.8) % of nights.Median obstructive apnea-hypopnea index (OAHI) decreased from 15.0 (7.8, 26.7) events/hour on diagnostic PSG to 1.4 (0.5, 4.7) events/hour on titration PSG.Median P PSG was 8.0 (7.0, 9.3) cmH 2 O, P MED was 7.6 (6.8, 8.7) cmH 2 O, and P 95 was 10.1 (8.9, 11.0) cmH 2 O. P MED and P 95 both correlated with P PSG (r=0.37,p=0.01; r=0.28, p=0.05).Bland-Altman plots showed fair agreement between P MED and P PSG (bias -0.4,SD 2.3) and P 95 and P PSG (bias 1.7, SD 2.5).Diagnostic OAHI significantly predicted P PSG (p<0.05) on median regression analysis, but there were no other predictors (age, sex, CCC).CONCLUSIONS APAP-derived pressures correlated with and were close to final CPAP pressures determined by titration PSG.APAP was safe and generally well-tolerated.Initiation of APAP should therefore be considered in children with CCC who are awaiting their titration PSG.This mitigating strategy is imperative with long PSG waitlists in Canada, and especially now, with increased delays caused by the COVID-19 pandemic.Financial support: none.