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Objective adherence to positive airway pressure therapy in an Australian paediatric cohort

  • Pediatrics • Original Article
  • Published:
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Abstract

Purpose

This study aimed to objectively measure adherence (compliance) and effectiveness of CPAP and BiLevel pressure support in an Australian paediatric population and determine factors associated with adherence outcomes.

Methods

Data was collected as part of routine clinical care from 2011 to 2013. Adherence was recorded by downloads from the PAP device. “Adequate” adherence was defined as ≥4 h/night for 70 % of days used. Effectiveness of therapy was measured by polysomnography (PSG) pre- and post-PAP initiation. One year follow-up was undertaken to determine the long-term utilisation of PAP therapy.

Results

Ninety-nine children were included (55 CPAP, 44 BiLevel). Mean age and BMI z-score were 6.9 ± 5.5 years and 0.1 ± 2.0 for CPAP and 9.8 ± 5.9 years and −0.5 ± 2.6 for BiLevel, respectively. At initial download, adequate adherence was observed in 75 % of CPAP and 91 % of BiLevel users. Mean hours of use (per night) for all nights used was 6.8 ± 2.8 and 9.3 ± 3.6 h, respectively. PSG demonstrated that CPAP use was associated with >60 % decrease in the obstructive apnoea hypopnoea index (OAHI, 19.0 ± 18.4 to 2.4 ± 3.1; p < 0.001). BiLevel use was associated with improved baseline SaO2 and TcCO2 (SaO2, 92.5 ± 5.4 % to 95.5 ± 2.9 %; p = 0.001 and reduction in TcCO2, 50.0 ± 10.9 mmHg to 44.8 ± 7.6 mmHg; p = 0.01). At follow-up, 22 (40 %) patients on CPAP and 26 (59 %) on BiLevel continued with therapy, and amongst these, adequate adherence was maintained in 76 % of CPAP and 80 % of Bilevel users.

Conclusions

In this Australian paediatric cohort (predominantly non-obese), adherence with BiLevel was greater than for CPAP. Over half of our population continue to utilise PAP therapy 1 year later, and amongst these cases, adequate adherence was maintained.

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Abbreviations

AHI:

Apnoea hypopnoea index

BiLevel:

Bilevel positive airway pressure

BMI:

Body mass index

CHW:

Children’s Hospital at Westmead

CPAP:

Continuous positive airway pressure

NIV:

Non-invasive positive airway pressure

OSA:

Obstructive sleep apnoea

PAP:

Positive airway pressure

PSG:

Polysomnography

SaO2 :

Oxygen saturation

SDB:

Sleep disordered breathing

TcCO2 :

Transcutaneous pCO2

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Acknowledgments

Dr. Machaalani is supported by the SIDS stampede.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Sydney, Sydney, NSW, 2006, Australia

    Rita Machaalani, Carla A Evans & Karen A. Waters

  2. The Children’s Hospital, Westmead, Sydney, NSW, 2145, Australia

    Rita Machaalani & Karen A. Waters

Authors
  1. Rita Machaalani
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  2. Carla A Evans
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  3. Karen A. Waters
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Corresponding author

Correspondence to Rita Machaalani.

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Funding

No funding was received for this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not obtained from individual participants included in the study since this was a retrospective report and we are reporting de-identified data.

Additional information

Location of study: The Children’s Hospital, Westmead, Sydney, NSW 2145, Australia

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Machaalani, R., Evans, C.A. & Waters, K.A. Objective adherence to positive airway pressure therapy in an Australian paediatric cohort. Sleep Breath 20, 1327–1336 (2016). https://doi.org/10.1007/s11325-016-1400-6

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  • DOI: https://doi.org/10.1007/s11325-016-1400-6

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