Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
J Clin Sleep Med. 2021 Jun 1;17(6):1183-1192. doi: 10.5664/jcsm.9162.
Despite the importance of treating sleep-disordered breathing, positive airway pressure adherence rates in children are low. Identifying readily available predictors of nonadherence would enable the development of targeted interventions and supports, but literature is limited. Our objective was to identify baseline clinical predictors of 6-month positive airway pressure therapy nonadherence in children with SDB through a retrospective cohort study.
This study evaluated children (ages 8-17 years) prescribed positive airway pressure therapy for sleep-disordered breathing between 2011 and 2017 at a single pediatric tertiary hospital. The primary outcome was nonadherence at 6 months, measured using both machine downloads and self-report. Candidate baseline predictors included demographics, comorbidities, and sleep-disordered breathing characteristics. Relative risks (RR) and 95% confidence intervals (CI) were estimated using a modified Poisson regression. Missing data were imputed prior to analysis.
The study included 104 children. The independent predictors most strongly associated with greater nonadherence were older age (RR = 1.08 for a 1-year increase; 95% CI, 1.00-1.16) and higher oxygen saturation nadir (RR = 1.03 for a 1% increase; 95% CI, 1.00-1.05), whereas those most strongly associated with lower nonadherence were higher arousal index (RR = 0.97 for a 1 event/h increase; 95% CI, 0.95-1.00), developmental delay (RR = 0.58; 95% CI, 0.30-1.13), and asthma (RR = 0.72; 95% CI, 0.44-1.17).
Overall, children who are older, have less-severe sleep-disordered breathing, or less-disrupted sleep at baseline are more likely to be nonadherent to positive airway pressure therapy and may benefit from additional supports to acclimatize to therapy. As clinical predictors were only weakly associated with nonadherence, nonclinical characteristics may play a larger role in predicting adherence.
尽管治疗睡眠呼吸障碍非常重要，但儿童使用正压气道疗法的依从率仍然较低。识别易于获得的不依从预测因素将有助于制定有针对性的干预和支持措施，但相关文献有限。我们的目的是通过回顾性队列研究，确定患有睡眠呼吸障碍（SDB）的儿童接受正压气道疗法治疗 6 个月时不依从的基线临床预测因素。
本研究评估了 2011 年至 2017 年期间在一家儿科三级医院接受正压气道疗法治疗睡眠呼吸障碍的儿童（年龄 8-17 岁）。主要结局是使用机器下载和自我报告来衡量 6 个月时的不依从性。候选基线预测因素包括人口统计学、合并症和睡眠呼吸障碍特征。使用修正泊松回归估计相对风险（RR）和 95%置信区间（CI）。在分析之前，对缺失数据进行了插补。
该研究共纳入 104 名儿童。与更高的不依从性最密切相关的独立预测因素是年龄较大（RR=1.08，每增加 1 岁；95%CI，1.00-1.16）和更低的氧饱和度最低点（RR=1.03，每增加 1%；95%CI，1.00-1.05），而与更低的不依从性最密切相关的是更高的觉醒指数（RR=0.97，每增加 1 次/小时事件；95%CI，0.95-1.00）、发育迟缓（RR=0.58；95%CI，0.30-1.13）和哮喘（RR=0.72；95%CI，0.44-1.17）。
总体而言，基线时年龄较大、睡眠呼吸障碍较轻或睡眠中断较少的儿童更有可能不依从正压气道疗法治疗，可能需要额外的支持来适应治疗。由于临床预测因素与不依从性的相关性较弱，非临床特征可能在预测依从性方面发挥更大的作用。
