(1334) Otitis Media Incidence and Recurrence in Pediatric OSA Patients Using CPAP: A Retrospective Cohort Study

Introduction: Children with obstructive sleep apnea (OSA) are at increased risk of otitis media (OM), yet the otologic effects of continuous positive airway pressure (CPAP) therapy in this population remain poorly defined. Given the known influence of positive airway pressure on nasopharyngeal pressure dynamics and differences in baseline disease severity among children treated with CPAP, this study evaluated whether CPAP therapy is associated with differences in OM outcomes in pediatric patients with OSA.

Methods: This retrospective cohort study utilized the TriNetX United States Collaborative Network to identify patients < 18 years diagnosed with OSA between 1/1/2015 and 12/31/2024. Patients were stratified into CPAP-treated and non-CPAP cohorts, with 1-to-1 propensity score matching performed based on age, sex, race, and ethnicity. Baseline comorbidities were compared before and after matching to assess residual clinical differences. Primary outcomes included OM risk estimates and episode counts for suppurative OM, nonsuppurative OM, and OM with effusion (OME).

Results: A total of 9,734 pediatric patients with OSA were included, with 4,867 per cohort. Despite balanced demographics, asthma, allergic rhinitis, adenotonsillar hypertrophy, and reflux remained more prevalent in the CPAP-treated cohort. There were no significant differences in the risk of suppurative OM (4.62% vs 5.01%, P=.37), nonsuppurative OM (2.75% vs 3.02%, P=.43), or OME (1.54% vs 2.03%, P=.07) between cohorts. Among patients who developed suppurative OM, the CPAP-treated cohort experienced more episodes than non-CPAP patients (3.17 vs 1.62, P<.001), while episode counts for other outcomes were similar.

Conclusions: CPAP therapy was not associated with increased OM risk in children . However, children on CPAP who develop suppurative OM may be at higher risk for recurrence, suggesting a potential role for closer otologic monitoring. Further work is needed to clarify underlying mechanisms and identify strategies to reduce recurrence in this population.