CONTINUOUS positive airway pressure (CPAP) therapy is a cornerstone in managing severe obstructive sleep apnea (OSA) in children. However, recent research indicates that the relationship between therapeutic CPAP pressures and OSA severity in pediatric patients is more nuanced than previously thought.
A study involving 153 children with OSA, predominantly those with complex cases, sought to explore the correlation between CPAP pressures and various clinical parameters. The cohort had a mean age of 3.7 years, with CPAP pressures averaging 8 ± 1 cmH₂O, ranging from 6 to 12 cmH₂O.
Key findings from the study include:
Age and CPAP Pressure: A slight positive correlation was observed between the age at CPAP initiation and the required therapeutic pressure (r = 0.226, p = 0.005).
OSA Severity Metrics: Therapeutic CPAP pressure showed modest correlations with baseline mixed and obstructive apnea-hypopnea index (MOAHI; r = 0.185, p = 0.025) and oxygen desaturation index (ODI; r = 0.300, p < 0.001). Additionally, there were negative correlations with mean (r = −0.230, p = 0.005) and minimal pulse oximetry (SpO₂; r = −0.318, p < 0.001). BMI z-score: No significant correlation was found between BMI z-scores and CPAP pressure, AHI, MOAHI, or ODI. These findings suggest that while there are slight associations between CPAP pressure and certain factors like age and specific OSA severity indices, the correlations are relatively weak. Notably, BMI does not appear to influence the therapeutic CPAP pressure in this pediatric population. The study underscores the potential role of other determinants, such as anatomical features, in predicting optimal CPAP levels. As polysomnography (PSG)-titrated CPAP procedures become more challenging, identifying reliable predictors for therapeutic CPAP pressures is increasingly relevant in clinical practice. Reference: Khirani S et al. Does therapeutic CPAP pressure correlate with OSA severity in children? Sleep Medicine. 2025;129:89-93. Anaya Malik | AMJ
