P104 Positional OSA in children: single-centre prevalence and associated CPAP adherence

Abstract Background Positional obstructive sleep apnoea (POSA) is an obstructive sleep apnoea (OSA) phenotype in which most obstructive events occur in supine sleep. For adults, recent guidelines and trials suggest positional OSA devices are suitable treatment alternatives to continuous positive airway pressure (CPAP). We sought to determine prevalence of POSA and associated rates of suboptimal CPAP adherence in children. Methods This single centre retrospective cohort study included all children >2 years of age prescribed CPAP from 01/01/2020–01/01/2023 through Queensland Children’s Hospital (QCH) for moderate-severe OSA. Children were classified as having POSA or not through examination of obstructive events and sleep position determined by their diagnostic polysomnography. POSA was defined according to three different established diagnostic criteria (Cartwright’s, Bignold’s and Amsterdam POSA criteria), modified for paediatric use. CPAP adherence was defined as on average >4 hours usage for ≥5 nights/week. Results Of 120 eligible participants (median age = 13 years), 34% were female, 62% were obese, 33% had a syndromic or neurodevelopmental diagnosis and 48% had undergone adenoidectomy +/- tonsillectomy. Depending on POSA definition, 34%-68% (41-73) of the 120 participants had POSA. One-third (32-36%, depending on POSA definition used) of those with POSA had suboptimal CPAP adherence based on their first CPAP download. Conclusion A significant proportion of children with OSA prescribed CPAP at QCH have POSA, some of whom struggle to maintain CPAP adherence. Positional device therapy may represent an appropriate alternative management strategy. However, well-designed prospective trials in children are needed.