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Predictors of positive airway pressure therapy adherence in children: a prospective study
Natalie DiFeo1, Lisa J Meltzer, Suzanne E Beck
1Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Positive airway pressure (PAP) adherence in children with obstructive sleep apnea is linked to family and demographic factors, not disease severity. Maternal education and race significantly influenced PAP use in this study.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Public Health
Background:
- Obstructive sleep apnea (OSA) in children is increasingly managed with positive airway pressure (PAP).
- Poor adherence to PAP therapy is a significant challenge in pediatric OSA treatment.
- Understanding factors influencing adherence is crucial for effective management.
Purpose of the Study:
- To investigate the relationship between demographic, psychosocial, and polysomnographic parameters and PAP adherence in children.
- To identify predictors of PAP use in a pediatric population with OSA.
Main Methods:
- Prospective study involving 56 children with OSA undergoing PAP therapy.
- Collection of demographic and psychosocial data via questionnaires.
- Objective measurement of PAP adherence at 1 and 3 months.
Main Results:
- Maternal education level was the strongest predictor of PAP adherence (nights used and hours per night).
- Lower adherence was observed in African American children compared to other racial groups.
- Adherence correlated inversely with age in typically developing children and showed a link with family social support at 3 months.
Conclusions:
- PAP adherence in pediatric OSA is primarily influenced by family and demographic factors, rather than clinical measures like apnea severity.
- Further research is recommended to explore the impact of maternal education, socioeconomic status, and cultural beliefs on adherence.
- Developing targeted adherence programs based on these factors is essential.
Study Objectives:
Children with obstructive sleep apnea are increasingly being treated with positive airway pressure (PAP), particularly if they have underlying medical conditions. Although PAP is an effective treatment, its use is challenging due to poor adherence. We hypothesized that demographic, psychosocial, and polysomnographic parameters would be related to PAP adherence. We therefore prospectively collected data potentially pertaining to PAP adherence, and correlated it with PAP use.
Methods:
Fifty-six patients and their parents completed a series of psychosocial questionnaires prior to PAP initiation. Objective adherence data were obtained after 1 and 3 months of PAP use.
Results:
The population was primarily obese; 23% had neurodevelopmental disabilities. PAP adherence varied widely, with PAP being worn 22 ± 8 nights in month-1, but mean use was only 3 ± 3 h/night. The greatest predictor of use was maternal education (p = 0.002 for nights used; p = 0.033 for mean h used/night). Adherence was lower in African American children vs other races (p = 0.021). In the typically developing subgroup, adherence correlated inversely with age. Adherence did not correlate with severity of apnea, pressure levels, or psychosocial parameters other than a correlation between family social support and nights of PAP use in month-3.
Conclusions:
PAP adherence in children and adolescents is related primarily to family and demographic factors rather than severity of apnea or measures of psychosocial functioning. Further research is needed to determine the relative contributions of maternal education, socioeconomic status and cultural beliefs to PAP adherence in children, in order to develop better adherence programs.
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