Can CPAP Therapy in Pediatric OSA Ever Be Stopped?

Abstract

Study Objectives: Continuous positive airway pressure (CPAP) has been increasingly used in children with obstructive sleep apnea (OSA), though it is unclear whether it can ever be ceased. We describe the clinical, demographic, and polysomnographic (PSG) characteristics of a cohort of children with OSA who were successfully weaned off CPAP. Methods: From a pediatric cohort on CPAP for OSA at the Queensland Children's Hospital between January 2016 and December 2017, a subgroup of children who were taken off CPAP were retrospectively studied. Results: CPAP therapy was stopped for 53 children over a 2-year period; 29 of these were excluded from analysis due to change to bilevel support (n = 2), transition to adult care (n = 12), or cessation due to poor adherence (n = 15). A total of 24 children [median (interquartile range, IQR) age 4.1 years (1.0-10.5); 18 males] were successfully weaned off CPAP therapy based on improvement in clinical and PSG parameters; and were included in the analysis. These children had a median (IQR) apnea-hypopnea index (AHI) of 9.8 (5.7-46.0) at CPAP initiation, which improved to 3.3 (0.4-2.2) at CPAP cessation after a median (IQR) duration of 1.0 (0.5-2.0) year. The reasons for CPAP cessation included improved symptoms and/or PSG parameters with time (n = 11); improvement after airway surgery (n = 7), and improvement of body mass index (n = 2). In four children, CPAP therapy was ceased after initial trial due to low physician perceived clinical benefit. Conclusions: This is the first study describing the characteristics of children and likely reasons for successful CPAP cessation. Children on CPAP should be regularly screened for ongoing CPAP need.

ERS statement on paediatric long-term noninvasive respiratory support

“…A significant number of children could be weaned from long term CPAP over time: o infants with OSA [147,218,219], o children with craniosynostosis [12,220] o children with Down syndrome [38] o children with "complex OSA" [13,175] o children with OSA type I [221] Weaning from long term NIV is less common (and less reported) than from CPAP [105,112,123,175] and in children with NMD as compared to children treated with NIV for other conditions [102]. However, this may change with the development of innovative therapies, in particular for SMA.…”

Hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea: A systematic review and meta-analysis

“…This result is comparable to that obtained using typical pediatric CPAP treatment. According to King et al, CPAP therapy decreased the AHI of pediatric patients from 9.8 (5.7–46.0) to 3.3 (0.4–2.2) ( 36 ). Interestingly, one study found that discontinuing HNS did not immediately revert patients to their initial AHI level ( 23 ).…”

Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea

“…PAP can be used for the long term, and some children may require support for months to years; however, patient needs may change over time. Patients should be carefully monitored for change in symptoms and changing needs [68]. Again, a growth spurt, surgical or orthodontia intervention or significant weight loss may reduce upper airway obstruction and associated sleep disordered breathing.…”