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Sleep Med ; 84: 352-355, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242925


OBJECTIVES: Adherence to Continuous Positive Airway Pressure (CPAP) in children can be challenging. Advancements in CPAP technology have potential to influence adherence. The aim of this study was to compare adherence rates of children with obstructive sleep apnoea (OSA) initiated on autotitrating CPAP (APAP) with remote modem monitoring compared to a cohort started on fixed pressure CPAP alone. METHODS: Children aged over 3 years starting APAP at our centre between February 2017 and February 2020 were included. Therapy data was obtained for the initial 90 days. Data was compared to a cohort of children started on CPAP between July 2004 and September 2008. RESULTS: A total of 61 patients with a median age of 14.3 years formed the APAP group, and were significantly older than the CPAP group who had a median age of 8.6 years (p = 0.02). Co-morbid conditions were present in 51% compared with 69% in the earlier cohort (p = 0.11). No significant difference was found in any adherence parameters between the groups. The value closest to achieving a significant difference was hours used per day used, with an median of 5.2 h in the CPAP group compared with 7.0 h in the APAP group (p = 0.07). Two-way ANOVA including age group (above or below 13 years) showed that both age group and treatment group (CPAP vs APAP) were significantly associated with a difference in adherence (F = 4.41, p = 0.006), with mean hours used on days used being highest in the APAP group aged under 13 years. However no significant interaction was found between age and treatment group. CONCLUSION: Despite the convenience for patients with outpatient initiation and ability to achieve optimal pressures quickly and remotely, our results show no improvement in adherence using APAP with remote monitoring, with the possible exception of children aged under 13 years. A large randomized controlled trial would be required to confirm these findings.

Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Cooperação do Paciente , Polissonografia , Apneia Obstrutiva do Sono/terapia
J Clin Sleep Med ; 16(10): 1655-1661, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32515344


STUDY OBJECTIVES: An increasing number of children with obstructive sleep apnea (OSA) require treatment with continuous positive airway pressure (CPAP). This study aimed to determine whether automatic respiratory indices from a CPAP device accurately predict manually determined respiratory indices derived from overnight polysomnography (PSG) in children. METHODS: Consecutive children undergoing manual CPAP titration PSG using a ResMed VPAP ST-A (S9) were included. The apnea-hypopnea index (AHI), apnea index (AI), and hypopnea index (HI) from automatic analysis of the CPAP device for that night (AHICPAP, AICPAP, and HICPAP) were compared with manually derived respiratory indices (RDIPSG, OAHIPSG, AIPSG, and HIPSG) using the Wilcoxon matched-pairs signed-ranks test. RESULTS: Forty-six children (32 boys; median age, 13.5 years; range, 4.6-20.0 years) were included. There was no difference between RDIPSG and AHICPAP (P = .6) nor between HIPSG and HICPAP (P = .2). AIPSG was significantly lower than AICPAP (mean difference -1.3 events/hr, P < .001). AIPSG and AICPAP were strongly correlated (r² = .72, P < .01), but the CPAP machine overestimated the number of apneas at higher AIs. OAHIPSG was significantly lower than AHICPAP (P = .003) but strongly correlated (r² = .87, P < .01). The CPAP device significantly underestimated the number of hypopneas at higher indices. Using the manually scored OAHIPSG of ≥5 events/hr to define significant residual OSA, the AHICPAP had a high specificity (0.95) but low sensitivity (0.20). CONCLUSIONS: The ResMed S9 respiratory indices are not accurate enough to guide treatment decisions in children; in particular, they do not rule out the presence of residual OSA in children that remain symptomatic on CPAP. A low AHICPAP is reassuring in the context of a stable patient but may miss ongoing hypopneas.

Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
J Clin Sleep Med ; 13(5): 713-719, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28356178


STUDY OBJECTIVES: Few studies have assessed autotitrating positive airway pressure (autoPAP) for treatment of obstructive sleep apnea (OSA) in children. We aimed to review our use of autoPAP for initiation of continuous positive airway pressure (CPAP) therapy in children, and compare autoPAP-derived treatment pressures to CPAP treatment pressure determined by attended polysomnography (PSG). METHODS: Retrospective review of children initiated on autoPAP from 2013 to 2015. Mean autoPAP pressure (AutoMean pressure) and average device pressure ≤ 90% of time (Auto90 pressure) were taken from downloaded data and compared to the recommended treatment pressure following titration PSG (PSG pressure). RESULTS: Fifty-two children started CPAP, of whom 26 (age ± standard deviation 11.9 ± 3.4 years) used autoPAP and had titration PSG. AutoPAP was used on average 84% of nights (standard deviation 20%) in the first month, with a mean ± standard deviation 6.3 ± 2.0 hours of use on nights used. The median (interquartile range) obstructive apnea-hypopnea index decreased from 16.6 (11, 35) events/h before treatment to 2.2 (0.4, 3.8) events/h on the titration PSG. Median (interquartile range) PSG pressure was 9.0 cm H2O (7.0, 10.0), AutoMean pressure was 6.3 cm H2O (5.3, 7.5), and Auto90 pressure was 8.1 cm H2O (7.1, 9.5). These were significantly different (P < .001), with the significant difference lying between AutoMean and the other two pressures. PSG pressure was greater than or equal to the AutoMean pressure in all cases, and greater than or equal to the Auto90 pressure in 20 out of 26 cases (77%). CONCLUSIONS: AutoPAP is a safe and effective means of initiating CPAP in children. AutoMean and Auto90 pressures are usually below treatment pressure determined by titration PSG.

Pressão Positiva Contínua nas Vias Aéreas/métodos , Apneia Obstrutiva do Sono/terapia , Criança , Feminino , Humanos , Masculino , Polissonografia , Estudos Retrospectivos , Resultado do Tratamento
J Pediatr ; 159(5): 802-7, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21601219


OBJECTIVE: To determine predictors of continuous airway pressure (CPAP) adherence in children. STUDY DESIGN: Analysis of CPAP usage data for children between 2004 and 2008. RESULTS: During the study period, 32 children were prescribed CPAP; 2 failed to accept the mask, and 30 (mean ± SD age 9.1 ± 5.3 years) were included in further analysis. In the first 2 to 3 months of treatment, average (± SD) CPAP use was 4.7 ± 2.7 hours/night. Hours of use were not affected by age, sex, baseline obstructive apnea-hypopnea index, intellectual disability, or socioeconomic status (P > .05). Of the children, 10 (33%) used CPAP for one hour or more on more than 6 nights per week and were defined as consistent users. Consistent users treated with CPAP for significantly longer on nights of use than intermittent users (7.2 ± 2.0 hours vs 4.7 ± 2.4 hours, P = .008). The hours of use differed between the two groups after the second night of treatment (P < .05), and this difference persisted for the first 3 months of therapy. CONCLUSIONS: Children who attempted to use CPAP at least 6 nights a week were treated with CPAP for a longer time on the nights of use. Usage in the first week of treatment predicted longer term use over 2 to 3 months. Monitoring adherence in the first week of treatment and intervening in cases of low adherence may improve long-term CPAP use.

Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Apneia Obstrutiva do Sono/terapia , Fatores Etários , Criança , Feminino , Humanos , Deficiência Intelectual , Masculino , Índice de Gravidade de Doença , Fatores Sexuais , Classe Social