Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care

Indra Narang; Tetyana Kendzerska; Austin Heffernan; Uzair Malik; Carolina G Carvalho; Clodagh M Ryan

doi:10.2147/NSS.S345143

Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care

Nat Sci Sleep. 2022 Feb 2:14:153-163. doi: 10.2147/NSS.S345143. eCollection 2022.

Authors

Indra Narang^#^{1

2}, Tetyana Kendzerska^#^{3

4}, Austin Heffernan⁵, Uzair Malik⁶, Carolina G Carvalho⁷, Clodagh M Ryan^{8

9}

Affiliations

¹ Department of Pediatrics, University of Toronto, Toronto, Canada.
² The Hospital for Sick Children, Toronto, Canada.
³ Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
⁴ The Ottawa Hospital Research Institute, Ottawa, Canada.
⁵ UBC, Faculty of Medicine, Vancouver, Canada.
⁶ RCSI University of Medicine and Health Sciences, Dublin, Ireland.
⁷ University Health Network.
⁸ Department of Medicine, University of Toronto, Toronto, Canada.
⁹ Sleep Research laboratory, KITE-UHN.

^# Contributed equally.

Abstract

Background: There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses.

Research question: Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA?

Study design and methods: Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders.

Results: Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01.

Interpretation: Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.

Keywords: CPAP adherence; CPAP compliance; obstructive sleep apnea; transition care; young adults.