Correlates of Pediatric CPAP Adherence
Open accessAbstract
Study objectives 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.Methods 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.Results 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.Conclusions 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.
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Continuous positive airway pressure is considered the first-line treatment in pediatric obstructive sleep apnea without adenotonsillar hypertrophy, although with low tolerance of 25% to 50% and risk of craniofacial sequels after long-term use.
“Continuous positive airway pressure (CPAP) is considered the first-line treatment in pediatric OSA without adenotonsillar hypertrophy, although with low tolerance (25% to 50%) 11 12 13 and risk of craniofacial sequels after long-term use. 14 15”
From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [12]
Evidence-based guidelines support continuous positive airway pressure treatment as an effective first-line treatment of obstructive sleep apnea in children without adenotonsillar hypertrophy, but it is complicated by low tolerance or high refusal (25%-50%).
“Evidence-based guidelines support the use of continuous positive airway pressure treatment (CPAP) as an effective first-line treatment of OSA in children without adenotonsillar hypertrophy; however, this is complicated by low tolerance or high refusal level of treatment (25%–50%).”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as [9]
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Cites
Berry, R. B., Budhiraja, R., Gottlieb, D. J., Gozal, D., Iber, C., Kapur, V. K., Marcus, C. L., Mehra, R., Parthasarathy, S., Quan, S. F., et al. (2012) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.2172 · Cited by 5,302 · see citing works
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71141-7 · Cited by 4,678 · see citing works
Sullivan, C., Berthon-Jones, M., Issa, F., & Eves, L. (1981) · The Lancet · doi:10.1016/s0140-6736(81)92140-1 · Cited by 2,731 · see citing works
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Marcus, C. L., Brooks, L. J., Draper, K. A., Gozal, D., Halbower, A. C., Jones, J., Schechter, M. S., Sheldon, S. H., Spruyt, K., Ward, S. D., et al. (2012) · Pediatrics · doi:10.1542/peds.2012-1671 · Cited by 2,432 · see citing works
DiMatteo, M. R. (2004) · Medical Care · doi:10.1097/01.mlr.0000114908.90348.f9 · Cited by 2,169 · see citing works
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Marcus, C. L., Brooks, L. J., Ward, S. D., Draper, K. A., Gozal, D., Halbower, A. C., Jones, J. E., Lehmann, C. U., Schechter, M. S., Sheldon, S. H., et al. (2012) · PEDIATRICS · doi:10.1542/peds.2012-1672 · Cited by 1,710 · see citing works
Adherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment
Weaver, T. E., & Grunstein, R. R. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-119mg · Cited by 1,680 · see citing works
Knochenhauer, E. S., Key, T. J., Kahsar-Miller, M., Waggoner, W., Boots, L. R., & Azziz, R. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.83.9.5090 · Cited by 1,568 · see citing works
A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea
Marcus, C. L., Moore, R. H., Rosen, C. L., Giordani, B., Garetz, S. L., Taylor, H. G., Mitchell, R. B., Amin, R., Katz, E. S., Arens, R., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1215881 · Cited by 1,422 · see citing works
Knochenhauer, E. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.83.9.3078 · Cited by 1,134 · see citing works
Weaver, T. E., Maislin, G., Dinges, D. F., Bloxham, T., George, C. F. P., Greenberg, H., Kader, G., Mahowald, M., Younger, J., & Pack, A. I. (2007) · Sleep · doi:10.1093/sleep/30.6.711 · Cited by 1,058 · see citing works
Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B., White, J., Wright, J., & Cates, C. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub2 · Cited by 1,001 · see citing works
Sawyer, A. M., Gooneratne, N. S., Marcus, C. L., Ofer, D., Richards, K. C., & Weaver, T. E. (2011) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2011.01.003 · Cited by 900 · see citing works
Kushida, C. A., Littner, M. R., Hirshkowitz, M., Morgenthaler, T. I., Alessi, C., Bailey, D. R., Boehlecke, B. A., Brown, T. M., Coleman, J., Friedman, L., et al. (2006) · SLEEP · doi:10.1093/sleep/29.3.375 · Cited by 774 · see citing works
Sassani, A., Findley, L. J., Kryger, M., Goldlust, E., George, C., & Davidson, T. M. (2004) · Sleep · doi:10.1093/sleep/27.3.453 · Cited by 506 · see citing works
Beebe, D. W. (2006) · Sleep · doi:10.1093/sleep/29.9.1115 · Cited by 446 · see citing works
Marcus, C. L., Rosen, G. M., Ward, S. L. D., Halbower, A. C., Sterni, L. M., Lutz, J., Stading, P., Bolduc, D. B., & Gordon, N. D. (2006) · PEDIATRICS · doi:10.1542/peds.2005-1634 · Cited by 425 · see citing works
Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B. J., White, J., Wright, J., & Cates, C. J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub3 · Cited by 383 · see citing works
Milleron, O. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.02.008 · Cited by 370 · see citing works
Early CPAP Use Identifies Subsequent Adherence to CPAP Therapy
(2007) · Sleep · doi:10.1093/sleep/30.3.320 · Cited by 329 · see citing works
Practice Parameters for the Medical Therapy of Obstructive Sleep Apnea
Standards of Practice Committee of the American Academy of Sleep Medicine, Morgenthaler, T. I., Kapen, S., Lee-Chiong, T., Alessi, C., Boehlecke, B., Brown, T., Coleman, J., Friedman, L., Kapur, V., et al. (2006) · Sleep · doi:10.1093/sleep/29.8.1031 · Cited by 299 · see citing works
Gender Differences in the Expression of Sleep-Disordered Breathing
Mohsenin, V. (2001) · CHEST Journal · doi:10.1378/chest.120.5.1442 · Cited by 265 · see citing works
A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea
Marcus, C. L., Moore, R. H., ROSEN, C. L., Giordani, B., Garetz, S. L., Taylor, H. G., Mitchell, R. B., Amin, R. S., Katz, E. S., Arens, R., et al. (2014) · Survey of Anesthesiology · doi:10.1097/01.sa.0000441005.88110.fc · Cited by 264 · see citing works
DiMatteo, M. R. (2004) · Patient Education and Counseling · doi:10.1016/j.pec.2003.04.003 · Cited by 222 · see citing works
Adherence to Pediatric Medical Regimens
Rapoff, M. A. (2010) · Issues in Clinical Child Psychology · doi:10.1007/978-1-4419-0570-3 · Cited by 219 · see citing works
Marcus, C. L., Radcliffe, J., Konstantinopoulou, S., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201112-2167oc · Cited by 178 · see citing works
Factors that influence CPAP adherence: an overview
Shapiro, G., & Shapiro, C. (2010) · Sleep and Breathing · doi:10.1007/s11325-010-0391-y · Cited by 172 · see citing works
Predictors of Obstructive Sleep Apnea Severity in Adenotonsillectomy Candidates
Weinstock, T. G., ROSEN, C. L., Marcus, C. L., Garetz, S. L., Mitchell, R. B., Amin, R. S., Paruthi, S., Katz, E. S., Arens, R., Weng, J., et al. (2014) · SLEEP · doi:10.5665/sleep.3394 · Cited by 164 · see citing works
Compliance Rates in Children Using Noninvasive Continuous Positive Airway Pressure
O'Donnell, A. R., Bjornson, C., Bohn, S. G., & Kirk, V. G. (2006) · SLEEP · doi:10.1093/sleep/29.5.651 · Cited by 143 · see citing works
Predictors of Positive Airway Pressure Therapy Adherence in Children: A Prospective Study
DiFeo, N., Meltzer, L. J., Beck, S. E., Karamessinis, L. R., Cornaglia, M. A., Traylor, J. T., Samuel, J. M., Gallagher, P. R., Radcliffe, J., Beris, H., et al. (2012) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.1914 · Cited by 117 · see citing works
Continuous positive airway pressure and noninvasive ventilation adherence in children
Ramirez, A., Khirani, S., Aloui, S., Delord, V., Borel, J., Pépin, J., & Fauroux, B. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.06.020 · Cited by 100 · see citing works
Sleep Apnea, Hypertension, and the Effects of Continuous Positive Airway Pressure
DHILLON, S., CHUNG, S., FARGHER, T., HUTERER, N., & SHAPIRO, C. (2005) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2004.11.031 · Cited by 74 · see citing works
Hsiao, K. H., & Nixon, G. M. (2007) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2007.01.003 · Cited by 68 · see citing works
Beebe, D. W., & Byars, K. C. (2011) · PLoS ONE · doi:10.1371/journal.pone.0016924 · Cited by 68 · see citing works
Simon, S. L., Duncan, C. L., Janicke, D. M., & Wagner, M. H. (2011) · Sleep Medicine · doi:10.1016/j.sleep.2011.10.026 · Cited by 67 · see citing works
Self-citationRYAN, S., GARVEY, J. F., SWAN, V., BEHAN, R., & MCNICHOLAS, W. T. (2011) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00873.x · Cited by 56 · see citing works
Balachandran, J. S., Yu, X., Wroblewski, K., & Mokhlesi, B. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.2476 · Cited by 53 · see citing works
Başoğlu, Ö. K., Midilli, M., Midilli, R., & Bilgen, C. (2011) · Sleep And Breathing · doi:10.1007/s11325-011-0631-9 · Cited by 49 · see citing works
Optimal treatment of obstructive sleep apnea and excessive sleepiness
Rosenberg, R. P., & Doghramji, P. P. (2009) · Advances in Therapy · doi:10.1007/s12325-009-0016-7 · Cited by 45 · see citing works
Understanding the problem of poor CPAP adherence
Aloia, M. S. (2011) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2011.04.002 · Cited by 28 · see citing works
Shott, S. R. (2011) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e32834c1728 · Cited by 28 · see citing works
Enhancing Adherence to Positive Airway Pressure Therapy for Sleep Disordered Breathing
Russell, T. D. (2014) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0034-1390070 · Cited by 27 · see citing works
Effect of Short Term C PAP Therapy in Obstructive Sleep Apnea Patients with Metabolic Syndrome
Kanimozhi, S. (2015) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2015/13301.5859 · Cited by 15 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Quittner A, Espelage D, levers-Landis C, Drotar D. Measuring adherence to medical treatments in childhood chronic illness: considering multiple methods and sources of information. J Clin Psychol Med Settings 2000;7:41-54.
Cited by
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Wilcox, L. J., Bergeron, M., Reghunathan, S., & Ishman, S. L. (2017) · Laryngoscope Investigative Otolaryngology · doi:10.1002/lio2.118 · Cited by 107 · see citing works
Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
Gozal, D., Tan, H.-L., & Kheirandish-Gozal, L. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9030888 · Cited by 99 · see citing works
Bariani, R. C. B., Bigliazzi, R., Cappellette Junior, M., Moreira, G., & Fujita, R. R. (2022) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2021.02.010 · Cited by 28 · see citing works
Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review
Cozzi-Machado, C., Albertini, F. R., Silveira, S., & Machado-Júnior, A. J. (2023) · Sleep Science · doi:10.1055/s-0043-1776747 · Cited by 10 · see citing works
- Authors
- Hawkins, S. M. M., Jensen, E. L., Simon, S. L., & Friedman, N. R.
- Affiliations
- Children's Hospital Colorado (US)
- Corresponding author
- Hawkins, Stephen M.M.
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2016-06-15
- Volume
- 12
- Issue
- 6
- Pages
- 879-884
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC4877321
- OpenAlex
- W2418945464
- Cited by
- 102
- References
- 43
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 9 · 2023: 12 · 2022: 12 · 2021: 17 · 2020: 18 · 2019: 11 · 2018: 6 · 2017: 4
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001082)
- National Heart, Lung, and Blood Institute (T32HL007670)
- National Center for Research Resources (UL1RR025780)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- pediatric obstructive sleep apnea, CPAP adherence, continuous positive airway pressure, sex differences, developmental delay, Down syndrome, apnea-hypopnea index, insurance status, comorbidities, CPAP titration
- MeSH terms
- Child, Female, Humans, Male, Patient Compliance, Retrospective Studies, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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