Hawkins Stephen M M, Jensen Emily L, Simon Stacey L, Friedman Norman R
Department of Pediatric Pulmonology, University of Colorado School of Medicine, Aurora, CO.
The Breathing Institute, Children's Hospital Colorado, Aurora, CO.
J Clin Sleep Med. 2016 Jun 15;12(6):879-84. doi: 10.5664/jcsm.5892.
Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence.
A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test.
Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex.
Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.
阻塞性睡眠呼吸暂停（OSA）是一种常见的儿科疾病，其特征是睡眠期间反复出现部分或完全气流停止，通常是由于上呼吸道通畅不足所致。持续气道正压通气（CPAP）是一种可降低发病率的治疗选择。尽管努力推广使用，但CPAP在儿科和成人患者中的依从性都很差。我们试图确定人口统计学特征、保险状况、OSA严重程度、治疗压力或合并症是否与儿科患者的CPAP依从性有关。
对所有在一年期间开始或调整CPAP治疗且有实验室CPAP滴定记录的儿科患者的依从性下载数据进行回顾性分析。患者被分为CPAP依从组或非依从组，依从性定义为每晚使用时间>70%且平均每晚使用时间≥4小时。通过χ²检验分析两组之间的差异。
总体而言，近一半的参与者CPAP依从（49%，69/140）。在收集的人口统计学数据（年龄、种族、性别、保险状况）中，只有女性与更好的依从性相关（女性依从率为60.9%，男性为39.5%；优势比[OR]=2.41，95%置信区间[CI]=1.20 - 4.85；p = 0.01）。OSA的严重程度（诊断性呼吸暂停低通气指数[AHI]和低氧血症程度）、治疗压力和残余AHI均不影响CPAP依从性（p>0.05）。有发育迟缓（DD）的患者比无DD诊断的患者更可能依从CPAP（OR = 2.55，95%CI = 1.27 - 5.13；p = 0.007）。21三体综合征的女性患者往往更依从，但这未达到显著水平，也不能解释与女性相关的总体依从性增加。
我们的研究表明，CPAP治疗的依从性较差，但提示女性和发育迟缓与更好的依从性相关。这些发现支持了为理解儿科OSA的病理生理学以及开发促进依从性和替代干预措施所做的努力。
