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Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e442-e451 (doi:10.1542/peds.2005-1634)
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Adherence to and Effectiveness of Positive Airway Pressure Therapy in Children With Obstructive Sleep Apnea

Carole L. Marcus, MBBCha, Gerald Rosen, MDb, Sally L. Davidson Ward, MDc, Ann C. Halbower, MDd, Laura Sterni, MDd, Janita Lutz, RPsgTd, Pamela J. Stading, BSN, MPHb, Daisy Bolduc, BA, RPFT, MBAc, Nancy Gordon, MSe

a Division of Pulmonary Medicine and Sleep Center, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
b University of Minnesota School of Medicine, Children's Hospitals and Clinics of Minnesota, Pediatric Sleep Disorders Program, St Paul, Minnesota
c Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
d The Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland
e Gordon & Associates, Berkeley, California

OBJECTIVES. Positive airway pressure therapy (PAP) is frequently used to treat children who have obstructive sleep apnea syndrome and do not respond to adenotonsillectomy. However, no studies have evaluated objectively adherence to PAP in children, and few studies have evaluated objectively the effectiveness of PAP. The objective of this study was to determine adherence and effectiveness of PAP (both continuous [CPAP] and bilevel [BPAP] pressure) in children with obstructive apnea.

METHODS. A prospective, multicenter study was performed of children who were randomly assigned in a double-blind manner to 6 months of CPAP versus BPAP. Adherence was measured objectively using the equipment's computerized output. Effectiveness was evaluated using polysomnography.

RESULTS. Twenty-nine children were studied. Approximately one third of children dropped out before 6 months. Of the 21 children for whom 6-month adherence data could be downloaded, the mean nightly use was 5.3 ± 2.5 (SD) hours. Parental assessment of PAP use considerably overestimated actual use. PAP was highly effective, with a reduction in the apnea hypopnea index from 27 ± 32 to 3 ± 5/hour, and an improvement in arterial oxygen saturation nadir from 77 ± 17% to 89 ± 6%. Results were similar for children who received CPAP versus BPAP. Children also had a subjective improvement in daytime sleepiness.

CONCLUSIONS. Both CPAP and BPAP are highly efficacious in pediatric obstructive apnea. However, treatment with PAP is associated with a high dropout rate, and even in the adherent children, nightly use is suboptimal considering the long sleep hours in children.

Key Words: CPAP • BPAP • noninvasive ventilation • pediatrics • sleep-disordered breathing

Abbreviations: BP—blood pressure • OSAS—obstructive sleep apnea syndrome • CPAP—continuous positive airway pressure • PAP—positive airway pressure • FDA—Food and Drug Administration • BPAP—bilevel positive airway pressure • AHI—apnea hypopnea index • SaO2—arterial oxygen saturation • PSG—polysomnography • TST—total sleep time • EPAP—expiratory airway pressure

Accepted Aug 29, 2005.


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