Clinical predictors of non-adherence to positive airway pressure therapy in children: a retrospective cohort study.

STUDY OBJECTIVES Despite the importance of treating sleep-disordered breathing (SDB), positive airway pressure (PAP) adherence rates in children are low. Identifying readily-available predictors of non-adherence would enable the development of targeted interventions and supports, but literature is limited. Our objective was to identify baseline clinical predictors of six-month PAP therapy non-adherence in children with SDB through a retrospective cohort study. METHODS This study evaluated children (8-17 years) prescribed PAP therapy for SDB between 2011-2017 at a single pediatric tertiary hospital. The primary outcome was non-adherence at six months, measured using both machine downloads and self-report. Candidate baseline predictors included demographics, comorbidities, and SDB characteristics. Relative risks (RR) and 95% confidence intervals (95%CI) were estimated using a modified Poisson regression. Missing data were imputed prior to analysis. RESULTS The study included 104 children. The independent predictors most strongly associated with greater non-adherence were older age (RR=1.08 for a one 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), while those most strongly associated with lower non-adherence were higher arousal index (RR=0.97 for a one event/hour 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). CONCLUSIONS Overall, children who are older, have less severe SDB, or less disrupted sleep at baseline are more likely to be non-adherent to PAP therapy, and may benefit from additional supports to acclimatize to therapy. As clinical predictors were only weakly associated with non-adherence, non-clinical characteristics may play a larger role in predicting adherence.