0861 CHARACTERIZING TREATMENT EMERGENT CENTRAL SLEEP APNEA IN CHILDREN

Abstract

Treatment emergent central sleep apnea (TECSA) is a sleep disorder in which central apnea occurs once positive airway pressure has been applied to resolve obstructive apneas. TECSA has not been characterized in children. The purpose of this study is to determine the prevalence of TECSA in children and identify characteristics of children who develop TECSA. This retrospective study included children aged 0–18 started on long-term non-invasive ventilation who had both diagnostic and treatment polysomnography. The criteria for TECSA included: obstructive apnea-hypopnea Index (OAHI) ≥5 during the diagnostic study; improvement in OAHI on the treatment study; central apnea index (CAI) remaining the same or worsening from diagnostic to treatment study; and central apnea Index (CAI) ≥5 and accounting for ≥50% of the apnea-hypopnea index (AHI) during the treatment study. Each child with TECSA was matched to three children of similar age and sleep study date to construct a non-TECSA comparison group. Data collection included clinical characteristics in addition to the diagnostic, first and subsequent treatment studies. Out of our population of 146 children, 13 were identified as having TECSA for a prevalence of 8.9%. During diagnostic studies, TECSA children had significantly higher OAHI and AHI than non-TECSA children (OAHI: 29.5 ± 25.1 events/h vs 16.0 ± 15.0 events/h, p<0.05; AHI: 33.4 ± 24.7 events/h vs 19.6 ± 17.3 events/h, p<0.05). During titration studies, CAI and AHI were significantly higher in TECSA children than matched controls (CAI: 22.6 ± 32.1 events/h vs 2.0 ± 3.7 events/h, p<0.001; AHI: 29.6 ± 10.0 events/h vs 7.7 ± 9.4 events/h,p<0.001). The mean airway pressure for treatment did not differ between TECSA and non-TECSA children (6.9 ± 1.8 mmHg vs 6.5 ± 1.8 mmHg, p=ns). Six TECSA children had follow-up treatment studies; in 4 children (67%) criteria for TECSA was not met at follow-up. The prevalence of TECSA in children is similar to what is reported in adults. Higher obstructive indices during diagnostic sleep studies may provide an early indicator for TECSA risk. TECSA may be a transient phenomenon as the majority of TECSA children did not meet the criteria for the disorder at follow-up. A prospective study would be helpful to further explore this finding. None