• Research

Adherence in children using positive airway pressure therapy: a big-data analysis

Rakesh Bhattacharjee, Adam V Benjafield, Jeff Armitstead, Peter A Cistulli, Carlos M Nunez, Jean-Louis D Pepin, Holger Woehrle, Yang Yan, Atul Malhotra, on behalf of the medXcloud group



Positive  airway  pressure  (PAP)  has  become  a  prominent  treatment  for  children  with  sleep-disordered  breathing. However, there are no large-scale studies to clarify whether PAP is well tolerated in children, and which factors are associated with better adherence to PAP therapy. In this study, we aimed to clarify adherence patterns of PAP therapy in a large paediatric population.


We  did  a  cross-sectional  big-data  analysis  in  children  from  Oct  1,  2014,  to  Aug  1,  2018,  using  existing  data  derived from PAP devices uploaded nightly in the AirView cloud database. The AirView database is a usage tracking system available to all patients who are assigned PAP therapy, which requires consent from the patient or parent or guardian. All patients older than 4 years and younger than 18 years who used continuous or automated PAP devices were  evaluated.  Only  patients  living  in  the  USA  and  enrolled  with  a  single  insurance  company  were  included.  If  patients were participating in an engagement programme, programme onset must have been within 7 days of therapy onset. Our primary outcome was the proportion of patients who used PAP continuously over 90 days. The primary outcome was assessed in all patients who met the age inclusion criterion and had reliable age data available. Data on missing PAP use were imputed as zero, but data on other metrics were not imputed and excluded from analysis.


We used data recorded from Oct 1, 2014, to Aug 1, 2018. Of 40140 children screened, 36058 (89·8%) were US  residents  and  20553  (90·1%)  of  them  met  the  eligibility  criteria  and  had  accessible  data  (mean  age  13·0  years  [SD  3·7]).  On  the  basis  of  90  days  of  monitoring  data,  12699  (61·8%)  patients  continuously  used  PAP.  Factors  significantly  associated  with  adherence  includedage  group,  residual  apnoea–hypopnoea  index,  use  and  onset  of  patient engagement programmes, PAP pressure, and nightly median PAP mask leak, all over the 90-day study period.


To our knowledge, our study represents the largest analysis of children using PAP therapy to date. The findings suggest that adherence to PAP therapy is lower than in previous reports from adults. However, numerous actionable  factors  were  associated  with  improvements  in  adherence  and  should  be  used  strategically  in  clinical  decision making to improve PAP adherence in children



Published on January 24, 2020