Predictors of CPAP adherence in children & adolescents with obstructive sleep Apnoea

Abstract

Introduction: Obstructive Sleep Apnoea (OSA) is a common condition effecting 2-4% of children. Children are being increasingly treated with continuous positive airway pressure (CPAP), though ongoing adherence is a significant challenge. The purpose of this study was to identify and describe the factors associated with adherence to CPAP. Methods: We retrospectively reviewed the records and Polysomnography (PSG) scoring of children on CPAP for OSA during 2016 with a minimum of 6-month of CPAP usage data available. Our department has a streamlined CPAP initiation protocol with extensive education and post-initiation support. We studied the association of adherence (defined as median CPAP use per night of 4-hours or more for at least 6-months) with age, gender, obesity, Apnoea-Hypopnea Index (AHI) at diagnosis, change in AHI post treatment, socio-economic status (SES) and underlying aetiology. Results: 85 children (28F) were included with a median age (IQR) at CPAP initiation of 5.8 years (2.6- 12.2). 33(39%) were obese; 12 had Down's syndrome and 8 had Achondroplasia. AHI at diagnosis (n=76) was 14.35 (6.9-47.9) with a median improvement of 10.7 (4.4-40.8) with treatment. 57/78 (73%) children were considered adherent. Males were more likely to be adherent compared to females (80% adherence vs. 61%). Age, obesity, socio- economic status based on postcode, AHI at diagnosis and change in AHI with treatment did not predict adherence to CPAP therapy. Conclusion: In this retrospective study, CPAP adherence was variable, though high proportion was adherent. Boys reported higher adherence rates though severity of OSA and degree improvement with treatment did not predict adherence. Our adherence rates are higher than previously published work. Prospective qualitative research is needed for better understanding of adherence governing factors, and role of parent education at CPAP initiation and follow-up.L6223595602018-06-04 <br />