Predictors of CPAP adherence in children and adolescents with obstructive sleep apnoea

Abstract

Introduction/Aim: 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 its use is limited by poor adherence. 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. 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, socioeconomic 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%). Higher proportion of children with Achondroplasia were nonadherent (38% vs. 27%) though this difference was not statistically significant. 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 were adherent. Boys reported higher adherence rates though severity of OSA and degree improvement with treatment did not predict adherence. Prospective qualitative research is needed for better understanding of adherence governing factors, including data on patient and parent education at CPAP initiation and follow up.L6220917752018-05-16 <br />