Published online October 8, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1203-e1211 (doi:10.1542/peds.2006-2731)
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ARTICLE

Adherence to Nasal Positive Airway Pressure Therapy Among School-aged Children and Adolescents With Obstructive Sleep Apnea Syndrome

Elizabeth C. Uong, MDa, Mary Epperson, RNa, Sharon A. Bathon, RNa and Donna B. Jeffe, PhDb

a Division of Allergy and Pulmonary Medicine, Department of Pediatrics
b Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St Louis, Missouri

OBJECTIVES. Although many children with obstructive sleep apnea syndrome have complete resolution of obstructive sleep apnea syndrome after adenotonsillectomy, some patients have persistent obstructive sleep apnea syndrome requiring positive airway pressure treatment. Little is known about positive airway pressure adherence among school-aged children and adolescents.

PATIENTS AND METHODS. We retrospectively reviewed records from January 2000 through December 2004 to assess positive airway pressure adherence following a comprehensive patient- and parent-focused positive airway pressure education program for children 7 to 19 years of age with persistent obstructive sleep apnea syndrome subsequent to indicated adenotonsillectomy. A polysomnogram was obtained before and after initiation of positive airway pressure therapy. Adherence was defined as >4 hours per night and ≥5 nights per week of positive airway pressure use. Clock-counter meters determined hours per night and nights per week of positive airway pressure use; parents estimated hours per night of positive airway pressure use. Nonparametric tests assessed associations between adherence and various clinical parameters and symptoms.

RESULTS. Forty-six patients (56% male; 39% black, 61% white; mean age: 13.6 years; mean BMI: 39.8 kg/m2) were included. Two refused positive airway pressure. Meter readings were available for 27 patients (59%); positive airway pressure was used, on average, 7.0 hours per night, 73% of the week, and for a mean of 18.1 months. Nineteen (70%) were adherent regardless of age. There was good agreement between parental report and meter readings. Patients with greater improvement in apnea-hypopnea index were more likely to be adherent. Clinical parameters and symptoms improved after positive airway pressure therapy regardless of age or adherence.

CONCLUSIONS. In this retrospective study, positive airway pressure adherence and symptom improvement among school-aged children and adolescents was achieved with comprehensive patient and parent education and follow-up.

Key Words: positive airway pressure • obstructive sleep apnea • children • adolescents • adherence

Abbreviations: OSAS—obstructive sleep apnea syndrome • PAP—positive airway pressure • AHI—apnea-hypopnea index • SpO2—pulse oxygen saturation • TST—total sleep time • ETCO2—peak end-tidal CO2

Accepted May 7, 2007.