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Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea

Carole L Marcus1, Gerald Rosen, Sally L Davidson Ward

  • 1Division of Pulmonary Medicine, Sleep Center, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. marcus@email.chop.edu

Pediatrics
|March 3, 2006
PubMed

Insights

Positive airway pressure (PAP) therapy is effective for pediatric obstructive sleep apnea, but adherence is suboptimal. This study found that while PAP significantly improves apnea-hypopnea index and oxygen saturation, high dropout rates and short nightly use are concerns.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Respiratory Therapy

Background:

  • Positive airway pressure (PAP) therapy is a common treatment for pediatric obstructive sleep apnea (OSA) when adenotonsillectomy is ineffective.
  • Objective data on PAP adherence and effectiveness in children are limited.
  • This study addresses the need for objective evaluation of PAP in pediatric OSA.

Purpose of the Study:

  • To objectively determine adherence to PAP therapy in children with OSA.
  • To objectively evaluate the effectiveness of PAP (continuous [CPAP] and bilevel [BPAP]) in treating pediatric OSA.
  • To compare adherence and effectiveness between CPAP and BPAP in this population.

Main Methods:

  • A prospective, multicenter, double-blind study randomly assigned children to 6 months of CPAP or BPAP.
  • Objective adherence was measured using computerized equipment data.
  • Effectiveness was assessed via polysomnography, including apnea-hypopnea index and oxygen saturation.

Main Results:

  • Twenty-nine children were included; approximately one-third dropped out before 6 months.
  • Mean nightly PAP use among 21 children with downloadable data was 5.3 hours, with parental reports overestimating actual use.
  • PAP therapy demonstrated high efficacy, significantly reducing the apnea-hypopnea index and improving oxygen saturation nadir.

Conclusions:

  • Both CPAP and BPAP are highly effective for pediatric obstructive sleep apnea.
  • High dropout rates and suboptimal nightly usage in adherent children are significant challenges.
  • Further strategies are needed to improve long-term adherence and ensure adequate PAP usage in children.
Abstract

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