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Objective adherence to positive airway pressure therapy in an Australian paediatric cohort
Rita Machaalani1,2, Carla A Evans3, Karen A Waters3,4
1Department of Medicine, University of Sydney, Sydney, NSW, 2006, Australia. ritam@med.usyd.edu.au.
Insights
BiLevel positive airway pressure (PAP) therapy showed higher adherence than continuous positive airway pressure (CPAP) in Australian children. Over half of pediatric patients maintained adequate PAP therapy use after one year.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Medical Device Technology
Background:
- Obstructive sleep apnea and other respiratory disorders are prevalent in children.
- Positive airway pressure (PAP) therapy, including CPAP and BiLevel, is a common treatment.
- Objective adherence and effectiveness data in pediatric populations are crucial for optimizing treatment.
Purpose of the Study:
- To objectively measure adherence and effectiveness of CPAP and BiLevel PAP therapy in Australian children.
- To identify factors associated with adherence outcomes in pediatric PAP users.
- To assess long-term PAP therapy utilization in a pediatric cohort.
Main Methods:
- Retrospective data collection from clinical care (2011-2013).
- Adherence measured by PAP device downloads; adequate adherence defined as ≥4 hours/night for 70% of days used.
- Therapy effectiveness assessed via pre- and post-PAP polysomnography (PSG); 1-year follow-up for long-term utilization.
Main Results:
- Ninety-nine children (55 CPAP, 44 BiLevel) were analyzed.
- Initial adequate adherence was higher in BiLevel (91%) vs. CPAP (75%) users.
- CPAP significantly reduced obstructive apnea-hypopnea index (OAHI); BiLevel improved oxygen saturation (SaO2) and reduced end-tidal carbon dioxide (TcCO2).
- At 1-year follow-up, 59% of BiLevel and 40% of CPAP users continued therapy, with sustained adequate adherence.
Conclusions:
- BiLevel PAP therapy demonstrated superior adherence compared to CPAP in this Australian pediatric cohort.
- A significant proportion of pediatric patients continue PAP therapy long-term with maintained adequate adherence.
- Findings support the use of BiLevel PAP for specific pediatric respiratory conditions, warranting further investigation into adherence factors.
Purpose:
This study aimed to objectively measure adherence (compliance) and effectiveness of CPAP and BiLevel pressure support in an Australian paediatric population and determine factors associated with adherence outcomes.
Methods:
Data was collected as part of routine clinical care from 2011 to 2013. Adherence was recorded by downloads from the PAP device. "Adequate" adherence was defined as ≥4 h/night for 70 % of days used. Effectiveness of therapy was measured by polysomnography (PSG) pre- and post-PAP initiation. One year follow-up was undertaken to determine the long-term utilisation of PAP therapy.
Results:
Ninety-nine children were included (55 CPAP, 44 BiLevel). Mean age and BMI z-score were 6.9 ± 5.5 years and 0.1 ± 2.0 for CPAP and 9.8 ± 5.9 years and -0.5 ± 2.6 for BiLevel, respectively. At initial download, adequate adherence was observed in 75 % of CPAP and 91 % of BiLevel users. Mean hours of use (per night) for all nights used was 6.8 ± 2.8 and 9.3 ± 3.6 h, respectively. PSG demonstrated that CPAP use was associated with >60 % decrease in the obstructive apnoea hypopnoea index (OAHI, 19.0 ± 18.4 to 2.4 ± 3.1; p < 0.001). BiLevel use was associated with improved baseline SaO2 and TcCO2 (SaO2, 92.5 ± 5.4 % to 95.5 ± 2.9 %; p = 0.001 and reduction in TcCO2, 50.0 ± 10.9 mmHg to 44.8 ± 7.6 mmHg; p = 0.01). At follow-up, 22 (40 %) patients on CPAP and 26 (59 %) on BiLevel continued with therapy, and amongst these, adequate adherence was maintained in 76 % of CPAP and 80 % of Bilevel users.
Conclusions:
In this Australian paediatric cohort (predominantly non-obese), adherence with BiLevel was greater than for CPAP. Over half of our population continue to utilise PAP therapy 1 year later, and amongst these cases, adequate adherence was maintained.
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