The association between insomnia, chronotype, and positive airway pressure adherence in children and adolescents

Positive airway pressure (PAP) therapy is highly efficacious for the treatment of sleep-disordered breathing in children but is limited by poor adherence. We sought to evaluate the relationship between insomnia and chronotype on PAP adherence in children.

This is a cross-sectional study conducted at the Hospital for Sick Children (Toronto, Canada) of children aged 4-18 years old prescribed PAP for a minimum of six months. Self-reported and/or caregiver-reported questionnaires including the Pediatric Insomnia Severity Index and Children's Chronotype Questionnaire were completed. PAP therapy usage was measured using objective download data.

There were 159 participants included (median age = 14.2 years, females = 38%). Median PAP usage was 436.0 min/night (IQR 147.0, 516.0) for the morning group, 417.0 min/night (IQR 189.2, 538.8) for the intermediate group, and 161.5 min/night (IQR 6.0, 405.2) for the evening group. Children with an evening chronotype used PAP therapy for a median of 264.4 min less per night than children with an intermediate chronotype (95% CI 65.8, 397.1; p = 0.0018). Children used PAP therapy for 37.0 min less per night for each 1-point increase in the sleep maintenance problems score (95% CI 10.0, 47.7; p < 0.001) and 33.7 min less per night for each 1-point increase in the sleep onset problems score (95% CI 20.0, 39.5; p < 0.001). Sleep onset and sleep maintenance problems significantly influenced the relationship between chronotype and PAP usage.

We found that insomnia and evening chronotype were associated with reduced PAP adherence in children. These may be modifiable factors to promote PAP adherence.