Clinical predictors of nonadherence to positive airway pressure therapy in children: a retrospective cohort study

Henrietta Blinder; Franco Momoli; Stephen H Holland; Anna Blinder; Dhenuka Radhakrishnan; Sherri L Katz

doi:10.5664/jcsm.9162

Clinical predictors of nonadherence to positive airway pressure therapy in children: a retrospective cohort study

J Clin Sleep Med. 2021 Jun 1;17(6):1183-1192. doi: 10.5664/jcsm.9162.

Authors

Henrietta Blinder^{1

2}, Franco Momoli^{1

2}, Stephen H Holland^{1

3}, Anna Blinder^{1

3}, Dhenuka Radhakrishnan^{1

4

5

6}, Sherri L Katz^{1

4

5}

Affiliations

¹ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
² School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Division of Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
⁵ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ ICES uOttawa, Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada.

Abstract

Study objectives: Despite the importance of treating sleep-disordered breathing, positive airway pressure adherence rates in children are low. Identifying readily available predictors of nonadherence would enable the development of targeted interventions and supports, but literature is limited. Our objective was to identify baseline clinical predictors of 6-month positive airway pressure therapy nonadherence in children with SDB through a retrospective cohort study.

Methods: This study evaluated children (ages 8-17 years) prescribed positive airway pressure therapy for sleep-disordered breathing between 2011 and 2017 at a single pediatric tertiary hospital. The primary outcome was nonadherence at 6 months, measured using both machine downloads and self-report. Candidate baseline predictors included demographics, comorbidities, and sleep-disordered breathing characteristics. Relative risks (RR) and 95% confidence intervals (CI) were estimated using a modified Poisson regression. Missing data were imputed prior to analysis.

Results: The study included 104 children. The independent predictors most strongly associated with greater nonadherence were older age (RR = 1.08 for a 1-year increase; 95% CI, 1.00-1.16) and higher oxygen saturation nadir (RR = 1.03 for a 1% increase; 95% CI, 1.00-1.05), whereas those most strongly associated with lower nonadherence were higher arousal index (RR = 0.97 for a 1 event/h increase; 95% CI, 0.95-1.00), developmental delay (RR = 0.58; 95% CI, 0.30-1.13), and asthma (RR = 0.72; 95% CI, 0.44-1.17).

Conclusions: Overall, children who are older, have less-severe sleep-disordered breathing, or less-disrupted sleep at baseline are more likely to be nonadherent to positive airway pressure therapy and may benefit from additional supports to acclimatize to therapy. As clinical predictors were only weakly associated with nonadherence, nonclinical characteristics may play a larger role in predicting adherence.

Keywords: OSA; adherence; pediatric; positive airway pressure.

MeSH terms

Adolescent
Aged
Asthma*
Child
Continuous Positive Airway Pressure
Humans
Retrospective Studies
Sleep Apnea Syndromes*