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Positive airway pressure adherence in pediatric obstructive sleep apnea: A systematic scoping review
Alexa J Watach1, Melissa S Xanthopoulos2, Olufunke Afolabi-Brown2
1University of Pennsylvania, Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
Insights
Pediatric obstructive sleep apnea (OSA) treatment with positive airway pressure (PAP) therapy shows variable adherence. Factors like age and developmental delay influence PAP use, highlighting a need for better interventions.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Public Health
Background:
- Obstructive sleep apnea (OSA) in children has serious health implications.
- Positive airway pressure (PAP) therapy is a primary treatment for pediatric OSA.
- Understanding PAP utilization is crucial for managing pediatric OSA.
Purpose of the Study:
- To review PAP use in pediatric OSA patients.
- To identify factors influencing PAP therapy adherence.
- To explore interventions aimed at improving PAP use.
Main Methods:
- Systematic review of 20 studies on pediatric OSA and PAP therapy.
- Analysis of reported PAP adherence rates and usage duration.
- Examination of factors associated with PAP use and intervention effectiveness.
Main Results:
- Average PAP adherence was 56.9% (range: 24-87%).
- Average nightly PAP use ranged from 4.0 to 5.2 hours.
- Age, sex, and developmental delay were consistently linked to PAP use; interventions were largely unproven.
Conclusions:
- Significant heterogeneity exists in studies of pediatric PAP adherence.
- Key demographic factors influence PAP therapy utilization.
- Further research is needed to develop and test effective interventions to improve PAP use in children with OSA.
Abstract:
Positive airway pressure (PAP) therapy is a commonly prescribed treatment for pediatric obstructive sleep apnea (OSA). Negative health consequences associated with untreated OSA make understanding the utilization of PAP therapy imperative. The aim of this review was to describe PAP use in children and adolescents with OSA, explore factors that influence use, and describe published scientific or clinical approaches to improve use. Among 20 studies, average PAP adherence was 56.9% (range, 24-87%). PAP use averaged 4.0 h (SD = 3.1) to 5.2 h (SD = 3.4) per night. Cautious consideration of summary estimates of PAP use is necessary as studies were heterogeneous and adherence definitions widely varied across studies. Age, sex, and developmental delay were the only factors associated with PAP use in more than one study. The majority of approaches to improve use were program evaluations rather than scientifically tested interventions. This review identified critical gaps in the existing literature and sets forth a research agenda for the future.
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