Lessons learned in outpatient initiation and prescription of paediatric APAP

INTRODUCTION: Auto-titrating positive airway pressure (APAP) is increasingly used in children for treatment of obstructive sleep apnoea, with remote data monitoring used to assess initial pressure requirements. We aimed, over the first 4 weeks of treatment, to: 1) detail initial APAP prescription and changes needed; 2) compare adherence in children who required pressure changes to those who did not; and 3) determine if subsequent titration polysomnography resulted in further changes to APAP prescription. METHODS: Retrospective review of children commencing APAP from 2020 to 2025 at a single paediatric hospital, including: initial prescription, changes in the first 4 weeks, adherence during weeks 3-4 of treatment, and recommended pressure changes after titration polysomnography. RESULTS: O (IQR 10,12). 59 (41%) required ≥1 pressure changes during the first 4 weeks of treatment and this group had better adherence (93% vs 57% nights used (p < 0.001); hours of use days used 7.4h vs 4.2h (p < 0.001)). 83 children (58%) underwent titration polysomnography, with prescription change recommended in 50 (60%). Prescription changes during early treatment did not predict prescription change following titration polysomnography (p = 0.56). CONCLUSIONS: APAP prescription changes over the first 4 weeks of treatment is associated with better adherence, but the direction of this relationship is unclear. Despite early changes to APAP settings, changes were recommended after titration polysomnography in 60%, highlighting the ongoing need for polysomnography in a subgroup of patients.