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Adherence to positive airway pressure therapy in patients with Down syndrome: assessing cloud-based monitoring data
Rakesh Bhattacharjee1, Megan Warner2, Brandon Nokes3
1Department of Pediatrics, University of California San Diego, San Diego, California.
Insights
Patients with Down syndrome (DS) show good adherence to positive airway pressure (PAP) therapy, contrary to common assumptions. This study found DS patients may adhere to PAP therapy as well as or better than non-DS individuals.
Area of Science:
- Sleep Medicine
- Genetics
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is highly prevalent in individuals with Down syndrome (DS).
- Positive airway pressure (PAP) therapy is a common treatment for OSA in this population.
- Understanding adherence to PAP therapy in DS is crucial for effective management.
Purpose of the Study:
- To evaluate adherence to positive airway pressure (PAP) therapy in patients with Down syndrome (DS).
- To identify demographic and PAP therapy-related factors influencing adherence in DS patients.
- To compare PAP adherence in DS patients with a non-DS cohort.
Main Methods:
- Retrospective analysis of electronic health records and cloud-based PAP data from DS patients.
- Evaluation of adherence and usage metrics at 30- and 90-night intervals post-clinic visit.
- Comparison of adherence between DS patients and an age- and sex-matched cohort without DS.
Main Results:
- Median adherence was 56.7% at 30 nights and 34.4% at 90 nights, with no significant difference in usage.
- Demographic characteristics and PAP therapy parameters did not correlate with adherence or usage.
- Patients with DS demonstrated significantly higher PAP adherence compared to a matched cohort without DS.
Conclusions:
- Many patients with Down syndrome achieve successful adherence to PAP therapy.
- Findings challenge the misconception that DS patients struggle with PAP therapy adherence.
- DS patients may be as successful, or more so, in PAP therapy adherence than non-DS patients.
Study Objectives:
Obstructive sleep apnea is common in Down syndrome (DS) with many patients prescribed positive airway pressure (PAP) therapy. This study evaluates PAP adherence and identifies factors influencing adherence.
Methods:
Retrospective analysis of electronic health records and cloud-based PAP therapy data from patients with DS at Rady Children's Hospital, San Diego, CA. Cloud data were evaluated cross-sectionally at 30- and 90-night post-clinic visit and longitudinally in patients with ≥ 2 90-night data downloads. Outcomes included adherence (percentage of nights with ≥ 4 hours of use) and usage (percentage of nights with any PAP usage). The impact of demographic and PAP therapy factors (eg, mask leak) on these outcomes was also assessed.
Results:
Forty-seven patients with DS with cloud-based PAP therapy data over a 90-night period and 46 over a 30-night period were analyzed. The mean age was 17.7 ± 4.6 years (21 females). Median adherence was significantly higher at 30 nights (56.7%, interquartile range: 0.0, 90.8%) than at 90 nights (34.4%, interquartile range: 0.0, 86.7%) (P < .05). Median usage did not differ between the 30-night and 90-night periods. Demographic characteristics and PAP therapy parameters were not associated with adherence or usage. Among the longitudinal cohort (n = 32), median adherence was 69.7% (interquartile range: 19.2, 90.0%), and median usage was 78.2% (interquartile range: 45.2, 95.7%). Compared to an age- and sex-matched cohort without DS, patients with DS demonstrated higher PAP adherence (P < .05).
Conclusions:
Cross-sectional and longitudinal analyses reveal that many patients with DS successfully adhere to PAP therapy, challenging the misconception that they struggle with adherence and proving they may be as successful, if not more, than non-DS patients.
Citation:
Bhattacharjee R, Warner M, Nokes B, et al. Adherence to positive airway pressure therapy in patients with Down syndrome: assessing cloud-based monitoring data. J Clin Sleep Med. 2025;21(4):675-681.
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