0837 Average Volume-Assured Pressure Support (AVAPS) after CPAP Failure in A Pediatric Patient with Severe Obstructive Sleep Apnea and Sleep-Related Hypoventilation

Abstract

Abstract Introduction Obstructive sleep apnea (OSA) has become an increasingly pervasive sleep disorder in the pediatric population. Current mainstream treatments include adenotonsillectomy and positive airway pressure therapy. Average volume-assured pressure support (AVAPS) is a relatively new mode of non-invasive ventilation, which has been increasingly used in the treatment of respiratory failure and hypoventilation syndromes. Here we present a case of a pediatric patient with severe OSA and sleep-related hypoventilation who was successfully treated with AVAPS after failure of CPAP therapy. Report of Cases: A four year old boy with history of severe OSA, severe obesity, asthma, and allergic rhinitis underwent polysomnography one year after adenotonsillectomy and nasal turbinate reduction due to continued symptoms of sleep-disordered breathing. Results showed elevated residual apnea-hypopnea index (AHI = 30.4 events/hour), sleep-related hypoventilation (T ETCO2≥50 = 228.3 minutes), and sleep-related hypoxemia (T≤90% = 7 minutes). Therefore the patient underwent repeated adenotonsillectomy and turbinate reduction, with post-operative course complicated by pulmonary edema requiring intubation. He was extubated and weaned to nocturnal CPAP. Following discharge, CPAP titration failed to control AHI at maximal pressure (AHI 54.5 on 20 cm H2O, T≤90% = 15.3 minutes). The patient was then started on AVAPS with auto-titrating EPAP (AVAPS-AE, settings Pmax 20 cm H2O, PS 2-10 cm H2O, EPAP 5-10 cm H2O, RR auto, room air) with subsequent improvement of snoring and witnessed apneas, as well as reduction of daytime sleepiness. Afterwards, AVAPS-AE titration confirmed resolution of obstructive sleep apnea, sleep-related hypoxemia, and sleep-related hypoventilation (AHI = 2.5, T≤90% = 1.2 minutes, T ETCO2 ≥50 = 6.5 minutes.) The patient has since remained stable on AVAPS-AE until age ten, with the most recent AVAPS titration demonstrating continued resolution of sleep-disordered breathing. Conclusion AVAPS was an effective treatment for a pediatric patient with severe OSA and sleep-related hypoventilation who had failed CPAP therapy. Support (If Any) None.