Interpreting CPAP device respiratory indices in children

Abstract

Study Objectives: An increasing number of children with obstructive sleep apnea (OSA) require treatment with continuous positive airway pressure (CPAP). This study aimed to determine whether automatic respiratory indices from a CPAP device accurately predict manually determined respiratory indices derived from overnight polysomnography (PSG) in children. Methods: Consecutive children undergoing manual CPAP titration PSG using a ResMed VPAP ST-A (S9) were included. The apnea-hypopnea index (AHI), apnea index (AI), and hypopnea index (HI) from automatic analysis of the CPAP device for that night (AHI CPAP , AI CPAP , and HI CPAP ) were compared with manually derived respiratory indices (RDI PSG , OAHI PSG , AI PSG , and HI PSG ) using the Wilcoxon matched-pairs signed-ranks test. Results: Forty-six children (32 boys; median age, 13.5 years; range, 4.6-20.0 years) were included. There was no difference between RDI PSG and AHI CPAP (P = .6) nor between HI PSG and HI CPAP (P = .2). AI PSG was significantly lower than AI CPAP (mean difference −1.3 events/hr, P < .001). AI PSG and AI CPAP were strongly correlated (r 2 = .72, P <.01), but the CPAP machine overestimated the number of apneas at higher AIs. OAHI PSG was significantly lower than AHI CPAP (P =.003) but strongly correlated (r 2 = .87, P < .01). The CPAP device significantly underestimated the number of hypopneas at higher indices. Using the manually scored OAHI PSG of ≥5 events/hr to define significant residual OSA, the AHI CPAP had a high specificity (0.95) but low sensitivity (0.20). Conclusions: The ResMed S9 respiratory indices are not accurate enough to guide treatment decisions in children; in particular, they do not rule out the presence of residual OSA in children that remain symptomatic on CPAP. A low AHI CPAP is reassuring in the context of a stable patient but may miss ongoing hypopneas.

Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome

“…Currently, there are limited data comparing the measurement of AHI by the gold-standard PSG and home-NIV machine downloadable data. Mihai et al, 48 those with severe OSA showed a reduced number of days used. 30,50 Upper airway surgery is often the first-line treatment of OSA in children with DS.…”

“…Currently, there are limited data comparing the measurement of AHI by the gold‐standard PSG and home‐NIV machine downloadable data. Mihai et al, 48 concluded that the ResMed S9 home CPAP device significantly underestimated residual OSA and may not be diagnostic in terms of respiratory indices; however, a diminishing AHI is reassuring in the context of a stable patient. Khirani et al, 49 also compared built‐in software automatic scoring in‐home CPAP machines to PSG manual measures of AHI.…”

Improvement in quality of life with continuous positive airway pressure outweighs the treatment burden in children with obstructive sleep apnea

“…However these studies were of obese children without co‐morbidities 16 or with small numbers of comorbidities (17%) 15 and poor CPAP adherence (average CPAP use was only 2.8 h/night) 15 or adherence was not reported at followup 16 . Previous studies from our group in Australia reflect a different population, 3,17,18 with higher co‐morbid syndromes (65−73%) and higher average hours of use (4.7−6.3 h/night). Furthermore, these previous studies used a general measure of QOL in children (the PedsQL 15,16 ) which may miss domains of QOL particularly relevant to children with intellectual disability 19 and does not address sleep symptoms.…”

Mask interfaces and devices for home noninvasive ventilation in children

“…Some studies have shown that the breathing pattern data may not be accurate, 39 and the residual respiratory events overestimated. [40][41][42] The built-in software data should therefore always be considered with caution. A recent bench study, hypothesizing that patient's breathing detection is based on a minimal tidal volume, reported that some level I and II CPAP devices may be suitable for younger children, however, these findings have not been clinically validated.…”