Can CPAP therapy for paediatric OSA ever be stopped

Introduction: Continuous Positive Airway Pressure (CPAP) has been increasingly used in treatment of paediatric Obstructive Sleep Apnoea (OSA) not resolved by surgical intervention. It is unclear what proportion of children can be successfully taken off CPAP and the factors that govern this cessation. Aims: To describe the clinical, demographic and polysomnographic (PSG) characteristics of a cohort of children on CPAP for OSA, who were weaned off CPAP. Methods: From a cohort of children on CPAP for OSA at the Queensland Children’s Hospital between 2016-17, a group of children who were taken off CPAP were selected. Those who were transitioned to adults, changed to bilevel support or stopped due to non-adherence were excluded. Results: CPAP therapy was stopped for 53 children over a two-year period, 28 of these were excluded. 24 children [mean(SD) age 6.1(5.5) years; 18 M] were successfully weaned off CPAP therapy based on clinical judgement and PSG data analysis; and were included in the final analysis. These children had a median(IQR) AHI of 9.8(5.7-46.0) at CPAP initiation, and after a median(IQR) duration of 1.0 (0.5-2.0) year, had an improvement in median AHI to 3.0(1.9–4.8) at CPAP cessation. The reasons for CPAP cessation included improvement post airway surgery in (n=7); weight loss (n=2) and improved symptoms and/or PSG parameters with time (n=11). In 4 children, CPAP therapy was ceased after initial trial due to poor tolerance and low physician perceived clinical benefit. Conclusion: This is one of the first studies describing the characteristics of children successfully weaned off CPAP therapy. Children on CPAP should be regularly screened for ongoing symptoms and need for pressure support checked as a small group can be weaned.