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Factors related to positive airway pressure therapy adherence in children with obesity and sleep-disordered breathing

Sherri L Katz1,2, Valerie G Kirk3, Joanna E MacLean4

  • 1Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|February 8, 2020
PubMed

Insights

Children with obesity and sleep-disordered breathing (SDB) who had lower nocturnal oxygen saturation were more likely to adhere to positive airway pressure (PAP) therapy. Clinical team support and understanding of PAP are key for success.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Obesity Medicine

Background:

  • Positive airway pressure (PAP) therapy is crucial for treating children with concurrent obesity and sleep-disordered breathing (SDB).
  • Achieving consistent adherence to PAP therapy in this pediatric population presents significant challenges.
  • Identifying factors influencing adherence is vital for optimizing treatment outcomes.

Purpose of the Study:

  • To prospectively identify factors associated with positive airway pressure (PAP) adherence in children with obesity prescribed PAP for newly diagnosed sleep-disordered breathing (SDB).

Main Methods:

  • A prospective cohort study involving children with obesity and newly diagnosed SDB requiring PAP therapy.
  • Adherence was assessed using PAP machine downloads, diaries, and physician assessments (defined as PAP use ≥4 hours/night on >50% of nights).
  • A questionnaire evaluated factors related to adherence, administered ≥12 months post-enrollment. Clinical data including oxygen saturation nadir were compared between adherent and nonadherent groups.

Main Results:

  • Of 14 children (median age 14.3 years, 93% male, all with obstructive sleep apnea), 79% were adherent to PAP therapy.
  • Lower nocturnal oxygen saturation nadir was significantly associated with PAP adherence (median difference: 8.9%; 95% CI: 1.7, 16.1).
  • No significant association was found between adherence and age, apnea-hypopnea index, or maximal carbon dioxide levels.

Conclusions:

  • Children with obesity-related SDB and lower nocturnal oxygen saturation are more likely to adhere to PAP therapy.
  • Ensuring adequate patient understanding of PAP therapy and robust clinical team support are critical for successful treatment.
  • These findings highlight the importance of monitoring oxygen saturation and providing comprehensive support to improve PAP adherence in pediatric obesity-related SDB.
Abstract

Keywords:
CPAPadherencechildrennoninvasive ventilationobesityobstructive sleep apneapositive airway pressurequalitativesleep-disordered breathingtreatment

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