Pediatric Positive Airway Pressure Adherence in Obstructive Sleep Apnea Enhanced by Family Member Positive Airway Pressure Usage.
Adherence to positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) remains a challenge in children. We hypothesized that the presence of another family member on PAP therapy (parent, sibling, other family member) would be associated with better adherence in the child.



We conducted a retrospective chart review to identify children < 18 years of age who had a new diagnosis of OSA between Jan 2011 and May 2013. Outcomes were objective PAP adherence at 1 week, 1 month, and 3 months. Potential predictors included family member on PAP therapy, patient demographics, and clinical characteristics. Group differences between children with and without a family member on PAP therapy were determined using χ(2) test and Wilcoxon two-sample test. PAP adherence measures at each time point and patterns of change across time between the two groups were examined using mixed-effects models.



The final analytic sample included 56 children: age 13.2 ± 3.7 years, 60% male, 67% African American, 65% obese, and 32% with developmental disabilities. The mean obstructive apnea-hypopnea index was 25.2 ± 28.7, and 19 (33%) had a family member on PAP therapy. Overall PAP adherence was 2.8 ± 2.4 h/night at 3 months. At month 3, the group with a family member on PAP therapy had significantly greater average nightly PAP use on all nights (3.6 ± 0.6 vs. 2.3 ± 0.39) and on nights used (4.8 ± 0.6 vs. 3.8 ± 0.40); (p value = 0.04).



Overall PAP adherence was low, but having a family member on PAP therapy as a "role model" was associated with better adherence.



A commentary on this article appears in this issue on page 941.
Department of Pediatrics, Division of Pulmonology, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH.
Pooja
P
Puri
Department of Pediatrics, Division of Pulmonology, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH.
Kristie R
KR
Ross
Sleep Center, Neurologic Institute, Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
Reena
R
Mehra
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine Cleveland, Cleveland, OH.
James C
JC
Spilsbury
Center for Clinical Investigation, Statistical Science Core, Case Western Reserve University School of Medicine, Cleveland, OH.
Hong
H
Li
Department of Pediatrics, Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH.
Carolyn E
CE
Levers-Landis
Department of Pediatrics, Division of Pulmonology, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH.
Carol L
CL
Rosen
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001294:Attitude to Health; D002648:Child; D002652:Child Behavior / Q000523:psychology; D045422:Continuous Positive Airway Pressure / Q000523:psychology* / Q000706:statistics & numerical data*; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data*; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
adherence; children; obstructive sleep apnea; positive airway pressure (PAP)