0529 Average volume-assured pressure support as rescue therapy after CPAP failure in pediatric obstructive sleep apnea

Abstract

Abstract Introduction Average volume-assured pressure support with autotitrating EPAP (AVAPS-AE) is an automatically titrating mode of noninvasive ventilation (NIV) which provides a targeted tidal volume through adjustment of inspiratory pressures within a set range. In pediatric obstructive sleep apnea (OSA), adenotonsillectomy (AT) is often the first-line treatment and CPAP is often poorly tolerated as an alternative. We aimed to evaluate the efficacy of AVAPS as a potential option for children in whom CPAP titration is unsuccessful. Methods Retrospective review of records of children diagnosed with OSA with failed CPAP titration and in whom an in-laboratory AVAPS titration was performed. Results A total of 9 patients with OSA (8 male, age (95% CI) = 6.7 ± 2.6, BMI percentile (95% CI) = 81.0 ± 18.9) were identified. Of these patients, 6 had prior AT. All 9 patients had failed CPAP titration prior to AVAPS titration: 3 failed due to inability to control the apnea-hypopnea index (AHI, events/hour), 2 due to persistent hypercapnia, 2 due to treatment-emergent central sleep apneas, and 2 due to pressure intolerance. All 9 patients showed improvement in AHI following AVAPS titration (mean change = -17.9, 95% CI = 17.9 ± 9.5) as well as improvement in AHI from initial PSG to AVAPS titration (mean change = -42.5, 95% CI = 42.5 ±24.6). 7 patients had reduction in total sleep time with oximetry recording below 90% (T<90) from CPAP to AVAPS titration (mean change = -4.7 minutes, 95% CI = 4.7 ± 14.7), while 8 patients had reduction in T<90 from initial PSG to AVAPS titration (mean change = -14.0 minutes, 95% CI = 14.0 ±24.5). 7 patients had increase in REM sleep from CPAP to AVAPS titration (mean change = +15.9 minutes, 95% CI = 15.9 ±18.3), while 6 patients had increase in REM sleep from initial PSG to AVAPS titration (mean change = +7.7 minutes, 95% CI = 7.7 ±26.6). Conclusion In this case series of children with OSA and with failed CPAP titration, AVAPS is an effective treatment modality. Support (If Any)