Adherence to Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea in Children With Developmental Disabilities

Abstract

Study objectives: To determine whether adherence to positive airway pressure (PAP) differs in children with developmental disabilities (DD) compared to typically developing (TD) children.

Methods: PAP adherence of 240 children initiated on PAP for obstructive sleep apnea (OSA) was retrospectively analyzed. Adherence between groups, expressed as percentage of nights used and hours of usage on nights used at 3 and 6 months, was compared. Predictive factors of adherence were studied using a median regression model.

Results: A total of 103 children with DD (median [interquartile range] age = 7.9 [3.2-13.1] years) and 137 TD (11.0 [5.5-16.1], P = .005) children were included. Percentage of nights used was significantly higher in children with DD at 3 (DD = 86.7 [33.9-97.9], TD = 62.9 [30.8-87.8] P = .01) and 6 months (DD = 90.0 [53.3-100], TD = 70.7 [29.2-90.8], P = .003). Hours of usage on nights used at 3 and 6 months were similar between groups (DD = 5.0 [1.4-7.9], TD = 4.6 [1.9-7.2], P = .715; DD = 6.4 [1.8-8.3], TD = 5.7 [2.5-7.3], P = .345, respectively). This adherence measure improved over time in both groups (DD, P = .007; TD, P = .005). At 6 months, higher median neighborhood income and titration at or before 6 months were significantly predictive for percentage of nights used; higher PAP pressure was significantly predictive for hours of usage in both groups.

Conclusions: Children with DD had better PAP adherence expressed as percentage of nights used than TD children. Hours of usage on nights used at 3 and 6 months were similar between groups and improved over time. Higher income and titration at or before 6 months were predictive of adherence in all children. These findings indicate that children with DD can successfully wear PAP.

Keywords: adherence; children; developmental disabilities; obstructive sleep apnea; positive airway pressure.

© 2019 American Academy of Sleep Medicine.

Figures

Figure 1. Flow diagram of participants.

DD = developmental disabilities, OSA = obstructive sleep apnea, PAP = positive airway pressure, T&A = adenotonsillectomy, TD = typically developing.

Figure 2. Adherence over 6 months to PAP in DD and TD groups, expressed as % of nights used.

Children in the DD group had better PAP adherence at 6 months, expressed as % of nights used, than those in the TD group (P = .003). DD = developmental disabilities, PAP = positive airway pressure, TD = typically developing.

Figure 3. Adherence over 6 months to PAP in DD and TD groups, expressed as median daily use in hours.

Adherence expressed as hours of PAP used on the nights used significantly increased over time in both groups (DD P = .007; TD P = .005). However, this measure was similar between both groups (at 6 months, P = .345). DD = developmental disabilities, PAP = positive airway pressure, TD = typically developing.