Outcomes of Pediatric Titration Sleep Studies Following Empirical Use of Positive Airway Pressure and the Effect on Adherence to Therapy

• Published in: Respiratory care Vol. 67; no. 4; pp. 464 - 470
• Main Authors: Willis, L Denise, Spray, Beverly J, Scribner, April, Pruss, Kristi, Jambhekar, Supriya
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01-04-2022
• Subjects: Care and treatment; Child; Continuous Positive Airway Pressure - methods; Humans; Patient outcomes; Pediatric research; Polysomnography; Positive pressure respiration; Retrospective Studies; Sleep; Sleep apnea syndromes; Sleep Apnea, Obstructive; United States; obstructive sleep apnea; auto-titrating positive airway pressure; bi-level positive airway pressure; polysomnography; continuous positive airway pressure; positive airway pressure; pediatric; titration study
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.09521

Obstructive sleep apnea (OSA) is diagnosed through polysomnography (PSG) testing and commonly treated with positive airway pressure (PAP). The initial recommended treatment for pediatric OSA is adenotonsillectomy, but when this is contraindicated or ineffective, PAP is the next option. Children followed in our pediatric sleep disorders center who are diagnosed with OSA and meet criteria for therapy are empirically prescribed a PAP device, usually auto-titrating PAP (APAP), to avoid delays in therapy. Titration PSG is performed later to assess adequacy of settings. The aims of this study were to determine how often PSG titration results in changes to empirically prescribed PAP and to assess adherence to therapy before and after PSG titration.
A retrospective medical records review was completed for children diagnosed with OSA, prescribed PAP, and had a titration PSG within a 5-y consecutive period of 2008-2012. Demographic data, type of device, pressure settings, and adherence downloads were reviewed. Adherence was assessed before and after titration overall and compared for those who did and did not have therapy changes following titration.
The study included 121 participants. Median age at the time of the diagnostic PSG was 11 (interquartile range [IQR] 8-14) y. Most (106, 88%) were initially prescribed APAP. Median length of time between initial and follow-up PSG was 6.4 (IQR 4.4-10.1) months. The majority (94, 78%) had therapy changes following titration. Overall, adherence percentage > 4 h per night was not significantly increased post titration
= .47). There were no statistically significant differences in adherence between those who had therapy changes and those who did not
= .26).
Titration studies resulted in therapy modifications for most children. Adherence was not increased following the titration PSG. Changes in therapy did not result in increased adherence. Titration PSGs may optimize empirically prescribed settings.