Positive airway pressure (PAP) with home monitoring is effective in children with obstructive sleep apnea (OSA), according to a study in the Journal of Clinical Sleep Medicine.
Researchers conducted a real-world study to assess responses to PAP therapy with home monitoring in children and adolescents (aged 1 month to 18 years) treated for OSA between 2015 and 2019 at a children’s hospital. For all participants, home monitoring data were collected during the nights when PAP was used that included apnea hypopnea index (AHI) based on at least 1 hour of recording.
The investigators obtained data on demographics, clinical variables, and polysomnogram (PSG) parameters for all participants. The individual response to PAP therapy was calculated as the percentage of AHI reduction, comparing AHI in the initial PSG with the mean AHI from a downloaded data collected from PAP devices. The optimum PAP response was defined as a decrease in AHI of at least 75%.
The analysis included 195 participants (median age, 11.4 years; 60.5% male; 57.4% Black; 20% Hispanic; 14.3% White). The mean (SD) duration for adhering to the data collection protocol was 67 (31.2) days. Continuous PAP (CPAP) was the most frequently used PAP therapy (88.7 %).
Excellent responses to PAP therapy were observed in the children (median 85% AHI reduction), regardless of the specific type of PAP therapy used. Substantial heterogeneity was observed in the PAP responses. A total of 69.7% of participants achieved the best PAP response, which was defined as a decrease in AHI of at least 75%. Those who achieved this included those who had more severe OSA as well as those who were treated with higher PAP levels.
Female patients had a greater decrease in AHI vs male patients in response to PAP therapy (87.1% vs 84.5%, respectively; P =.014). Initial analysis demonstrated that Hispanic children had the lowest reduction in AHI (74.8%). However, after multivariate adjustment, only biological sex was a significant influencing factor, with female patients being 2 times more likely to have an AHI decrease of at least 75% (adjusted odds ratio [OR] 2.1; 95% CI, 1.05-4.18; P =.03).
Patients with an AHI reduction of at least 75% had greater body mass index (BMI), BMI z-score, and obesity diagnosis (BMI >30 kg/m2). After adjustment for age, biological sex, and race/ethnicity, individuals with obesity had almost a 3 times greater odds of having an AHI decrease of at least 75% (adjusted OR 2.92; 95% CI, 1.43-5.95; P =.003).
Among children with OSA, the best predictive model for individual PAP response included biological sex, obesity status, race, and obstructive AHI greater than 20/hour, which had a receiver operating characteristic curve of 0.79.
The researchers noted that their findings require additional validation in larger longitudinal studies. Also, because the data were obtained in an inner-city community with a large minority population, the results may not be applicable to other settings. In addition, the cross-sectional design prevented determination of the exact timing of PAP prescription and initiation, and the residual AHI reported by PAP devices may not be fully comparable to the indices from an in-lab titration study.
“Our results indicate that through the data obtained from home monitoring we can objectively determine the degree of response to PAP therapy in the pediatric population,” concluded the study authors. “The response to PAP in children is excellent with a median 85% AHI reduction. Based on our results, we propose that PAP responses using home monitoring can be analyzed to optimize PAP therapy in children of all ages based on real world evidence at the individual level.”
Aguilar A, Kahanowitch R, Weiss M, et al. Real world data evaluation of PAP responsiveness in pediatric obstructive sleep apnea. J Clin Sleep Med. Published online April 10, 2023. doi:10.5664/jcsm.10578