Objective adherence to positive airway pressure therapy in an Australian paediatric cohort

This study aimed to objectively measure adherence (compliance) and effectiveness of CPAP and BiLevel pressure support in an Australian paediatric population and determine factors associated with adherence outcomes.

Data was collected as part of routine clinical care from 2011 to 2013. Adherence was recorded by downloads from the PAP device. “Adequate” adherence was defined as ≥4 h/night for 70 % of days used. Effectiveness of therapy was measured by polysomnography (PSG) pre- and post-PAP initiation. One year follow-up was undertaken to determine the long-term utilisation of PAP therapy.

Ninety-nine children were included (55 CPAP, 44 BiLevel). Mean age and BMI z-score were 6.9 ± 5.5 years and 0.1 ± 2.0 for CPAP and 9.8 ± 5.9 years and −0.5 ± 2.6 for BiLevel, respectively. At initial download, adequate adherence was observed in 75 % of CPAP and 91 % of BiLevel users. Mean hours of use (per night) for all nights used was 6.8 ± 2.8 and 9.3 ± 3.6 h, respectively. PSG demonstrated that CPAP use was associated with >60 % decrease in the obstructive apnoea hypopnoea index (OAHI, 19.0 ± 18.4 to 2.4 ± 3.1; p < 0.001). BiLevel use was associated with improved baseline SaO₂ and TcCO₂ (SaO₂, 92.5 ± 5.4 % to 95.5 ± 2.9 %; p = 0.001 and reduction in TcCO_2, 50.0 ± 10.9 mmHg to 44.8 ± 7.6 mmHg; p = 0.01). At follow-up, 22 (40 %) patients on CPAP and 26 (59 %) on BiLevel continued with therapy, and amongst these, adequate adherence was maintained in 76 % of CPAP and 80 % of Bilevel users.

In this Australian paediatric cohort (predominantly non-obese), adherence with BiLevel was greater than for CPAP. Over half of our population continue to utilise PAP therapy 1 year later, and amongst these cases, adequate adherence was maintained.