OBSTRUCTIVE SLEEP APNEA SYMPTOMS AND THEIR IMPROVEMENT WITH PAP IN THE PEDIATRIC POPULATION: A RETROSPECTIVE STUDY IN A PEDIATRIC SLEEP DISORDERS CENTER

Abstract Introduction Obstructive sleep apnea (OSA) is estimated to occur in 1% to 5% of the pediatric population1. The Agency for Healthcare Research and Quality (2021) recently released a draft report titled, “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea.”2 The conclusions of this report determined that the published evidence reviewed by the agency did not support that positive airway pressure (PAP) affects long term, clinically important outcomes. No pediatric studies were included in this report. Pediatric patients who require PAP are held to the same standards as adults regarding adherence and insurance requirements3. However, clinical symptoms to determine improvement of OSA symptoms in adults are not the same in children. Symptoms in the pediatric population such as decreased concentration, hyperactivity, memory impairment, learning disorders, nocturnal enuresis and growth impairment have improved with PAP and are important indicators in this population of improved clinical outcomes4. Methods Retrospective chart review was used to examine symptoms reported by pediatric patients initiated on PAP for OSA. Symptom information was extracted before and after initiation of PAP. A chi-Square test was used to determine if there was an association between PAP treatment and improved clinical symptoms. Results 235 patient records were reviewed. The distribution of sex was 150 (63.9%) males and 76 (32.3%) females. The mean age at PAP initiation was 12.0 (SD = 4.5), age range from 9 months to 19 years. Most frequent symptoms pre PAP initiation included excessive daytime sleepiness (51%), at least one of the daytime behaviors above (45%), and nocturnal enuresis (14%). Excluding patients with missing data, first and fourth visit post PAP initiation, 78% (221 patients; 66 missing) and 90% (90 patients; 12 missing), respectively, reported improvement in symptoms. Conclusion Results indicate that PAP is a beneficial treatment of OSA with improvement in symptoms specific to the pediatric population. Due to the clinically significant outcomes to growth and development that PAP provides to pediatric patients with OSA, we suggest that they should not be held to the same insurance requirements as adults and further studies should be conducted to validate these findings. Support (If Any)