0541 Auto PAP adherence determinants of children during the pandemic: A single center experience. (25th May 2022) - Rao, Harish
Abstract: Introduction: Obstructive sleep apnea (OSA) is characterized by episodes of partial or complete upper airway obstruction, associated with gas exchange abnormalities, and sleep disruption resulting in OSA syndrome. OSA in majority of children improves after adenotonsillectomy, but with comorbidities or severe OSA, there is a high risk of residual OSA. Positive airway pressure (PAP) is a more definitive therapy for residual OSA when well tolerated. Reported CPAP adherence in children varies from 11-78%, but data on AutoPAP (APAP) acceptability and adherence has not been described. Methods: Due to the limitations placed on PAP titration during the SARS-COV-2 pandemic, children (range 2-18 years) diagnosed with OSA at our institution were placed on APAP therapy (Auto CPAP or Auto BiPAP). We performed a retrospective analysis of APAP download data of children who met the criteria (adherence at 90 days>4 hours). Adherent (usage>70%) and non-adherent children were compared using Wilcoxon rank sum test. Logistic regression analyses were performed the effect of covariates including age, PSG AHI, Day 1-7 usage, Day 1-7 residual AHI, Day 1-14 usage, Day 1-14 residual AHI, Day 1-30 usage, Day 1-30 residual AHI or mean pressure at 90 day on compliance at 90 days. Results: On day 90, 73 out of 90 children (40 boys) were using APAP >4 hours. Age, diagnostic PSG AHI, residual AHI (days 1-7; 1-14, 1-30), APAP median pressure, pressure (95% centile), and pressure (maximum) had no effect on adherence. Adherence at days (1-7; 1-14; 1-30) and day 1-90 residual AHI had a positive effect on adherence at day 90. There was no statistically significant difference in BMI z-score, age, PSG AHI, median pressure between the two groups. However, residual AHI was lower in the compliant group. Conclusion: APAP was fairly well accepted in our study with the majority of children with usage > 4 hours at day 90. Adherence on (days 1-7 and 1-30) predicted APAP usage at day 90. This mirrors adherence data from adult OSA patients. APAP was effective in the compliant group with lower residual AHI. Further analysis of adherence characteristics such as; family history of PAP, PAP mode, mask, surgery and comorbidities is planned. Support (If Any):