Predictors of early cpap adherence in children and adolescents with obstructive sleep apnoea

Abstract

Background: Obstructive Sleep Apnoea (OSA) affects 1-4% of children under five years of age. Adenotonsillectomy continues to be the first line treatment for paediatric OSA. Children are increasingly treated with continuous positive airway pressure (CPAP), though poor adherence can limit its use. Aim: In a cohort of children with OSA, to identify and describe the factors associated with CPAP initiation & adherence. Methods: We retrospectively reviewed the demographic, clinical and polysomnography (PSG) data of all children initiated on CPAP for OSA from January 2015 to November 2017. We studied the association of adherence (defined as median CPAP use per night of 4-hr or more for at least 6-months) with age, gender, BMI, Apnoea-Hypopnea Index (AHI), socio-economic status (SES), type of mask used, previous surgical intervention and underlying aetiology. Results: 108 children (41F; median age 8.6 years) were initiated on CPAP over this period, of which 43(39%) were obese; 19 had Down's syndrome, and 19 had craniofacial malformations. AHI at diagnosis [median (IQR)] (n=94) was 12.4 (5.6-23.4). 60/95 (63%) children were considered adherent. Females were more adherent (71% vs 58%) though obesity was not associated with adherence. Children with skeletal dysplasia reported significantly higher rates of non-adherence (80% non-adherent). Non-adherent children tended to be younger (mean age 7.66 vs 8.63 years), with higher BMI z score (1.16 vs 0.80), and higher AHI at CPAP initiation (27.02 vs 22.10); though these associations did not reach statistical significance. No difference in adherence was seen with mask type, previous airway surgery or SES. Conclusion: In this retrospective study, we included every child initiated on CPAP for OSA in Queensland and Northern New South Wales over a three-year period. CPAP adherence was variable, though high proportion (63%) were adherent. Females reported better adherence and children with skeletal dysplasia poorer-adherence; with a trend towards poorer adherence in younger children; those with higher BMI and more severe OSA. Targeting the adherence governing factor with a comprehensive patient and parent education at initiation and follow-up may improve outcome.L6246120012018-11-01 <br />