Sleep and Breathing

, Volume 20, Issue 4, pp 1327–1336 | Cite as

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

  • Rita Machaalani
  • Carla A Evans
  • Karen A. Waters
Pediatrics • Original Article



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.


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.


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.


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.


Bilevel CPAP Compliance Non-invasive ventilation NIV OSA 



Apnoea hypopnoea index


Bilevel positive airway pressure


Body mass index


Children’s Hospital at Westmead


Continuous positive airway pressure


Non-invasive positive airway pressure


Obstructive sleep apnoea


Positive airway pressure




Oxygen saturation


Sleep disordered breathing


Transcutaneous pCO2



Dr. Machaalani is supported by the SIDS stampede.

Compliance with ethical standards


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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Rita Machaalani
    • 1
    • 2
  • Carla A Evans
    • 1
  • Karen A. Waters
    • 1
    • 2
  1. 1.Department of MedicineUniversity of SydneySydneyAustralia
  2. 2.The Children’s HospitalSydneyAustralia

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