O012 APAP in children: pressure changes, adherence and need for polysomnography

Abstract Introduction Auto-titrating positive airway pressure (APAP) is commonly used in children starting CPAP treatment, with remote data monitoring used to assess initial pressure requirements. We aimed, over the first month of treatment, to 1) detail initial APAP settings 2) compare adherence in children who required pressure changes to those who did not; and 3) determine if titration polysomnography is necessary. Methods Retrospective review of children commencing APAP from 2020-2024, including: initial APAP prescription, setting changes in the first 4 weeks, adherence during weeks 3&4 of treatment, and recommended settings changes after titration polysomnography. Results 131 children commenced APAP (29%F; median 12.9y, range 2.7-19.6y; 79% overweight or obese; 49% other comorbid condition). Median (range) initial minimum APAP pressure was 4 (4-6)cmH2O, and maximum 10 (6-20)cmH2O. 55 (42%) required 1 or more pressure changes and this group had better adherence during the first month of acclimatisation (93% vs 61% nights used (p<.001); hours of use [days used] 7.5h vs 4.1h (p<.001)). 74 had a titration polysomnography, with a recommended prescription change in 44 (59%). Pressure changes during acclimatisation did not predict recommendation for change following titration polysomnography (p=.56). Discussion Change to APAP settings over the first month of treatment is associated with better adherence, but the direction of this relationship is unclear. Despite changes to APAP settings in the first month, additional changes were recommended after 59% of APAP titration polysomnography, highlighting the role for titration in a subgroup of patients; further research is required to better define those who benefit most.