Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Clin Sleep Med. 2012 Jun 15;8(3):279-86. doi: 10.5664/jcsm.1914.
Children with obstructive sleep apnea are increasingly being treated with positive airway pressure (PAP), particularly if they have underlying medical conditions. Although PAP is an effective treatment, its use is challenging due to poor adherence. We hypothesized that demographic, psychosocial, and polysomnographic parameters would be related to PAP adherence. We therefore prospectively collected data potentially pertaining to PAP adherence, and correlated it with PAP use.
Fifty-six patients and their parents completed a series of psychosocial questionnaires prior to PAP initiation. Objective adherence data were obtained after 1 and 3 months of PAP use.
The population was primarily obese; 23% had neurodevelopmental disabilities. PAP adherence varied widely, with PAP being worn 22 ± 8 nights in month-1, but mean use was only 3 ± 3 h/night. The greatest predictor of use was maternal education (p = 0.002 for nights used; p = 0.033 for mean h used/night). Adherence was lower in African American children vs other races (p = 0.021). In the typically developing subgroup, adherence correlated inversely with age. Adherence did not correlate with severity of apnea, pressure levels, or psychosocial parameters other than a correlation between family social support and nights of PAP use in month-3.
PAP adherence in children and adolescents is related primarily to family and demographic factors rather than severity of apnea or measures of psychosocial functioning. Further research is needed to determine the relative contributions of maternal education, socioeconomic status and cultural beliefs to PAP adherence in children, in order to develop better adherence programs.
患有阻塞性睡眠呼吸暂停的儿童越来越多地接受气道正压通气（PAP）治疗，尤其是在存在潜在医学疾病的情况下。尽管 PAP 是一种有效的治疗方法，但由于依从性差，其使用具有挑战性。我们假设人口统计学、心理社会和多导睡眠图参数与 PAP 依从性相关。因此，我们前瞻性地收集了可能与 PAP 依从性相关的数据，并将其与 PAP 使用情况相关联。
56 名患者及其父母在开始 PAP 治疗前完成了一系列心理社会问卷。在 PAP 使用 1 个月和 3 个月后获得了客观的依从性数据。
该人群主要肥胖；23%存在神经发育障碍。PAP 依从性差异很大，第 1 个月 PAP 使用 22±8 晚，但平均使用仅为 3±3 小时/晚。使用 PAP 最大的预测因素是母亲的教育程度（每晚使用的 p 值=0.002；每晚平均使用的 h 值=0.033）。与其他种族相比，非洲裔美国儿童的依从性较低（p=0.021）。在发育正常的亚组中，依从性与年龄呈负相关。除了家庭社会支持与第 3 个月 PAP 使用天数之间的相关性外，依从性与呼吸暂停严重程度、压力水平或心理社会参数均无相关性。
儿童和青少年的 PAP 依从性主要与家庭和人口统计学因素相关，而与呼吸暂停严重程度或心理社会功能测量无关。需要进一步研究以确定母亲教育、社会经济地位和文化信仰对儿童 PAP 依从性的相对贡献，以便制定更好的依从性计划。
