Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care

Abstract

Background

There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses.

Research Question

Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA?

Study Design and Methods

Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders.

Results

Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17–18), median BMI was 30.3 (IQR: 24.0–37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8–30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3–8.0) vs 2.6 hours/day (0.0–6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of −1.14; 95% CI −2.27 to −0.01.

Interpretation

Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.

Keywords:

• CPAP adherence
• transition care
• obstructive sleep apnea
• young adults
• CPAP compliance

Abbreviations

BMI, body mass index; CI, confidence interval; ESS, Epworth sleepiness scale; FSS, Fatigue severity Scale; GAD, Generalised anxiety disorder; IQR, interquartile range; ISI, insomnia severity index; OSA, Obstructive sleep apnea; PAP, Positive airway pressure; PHQ, Patient health questionnaire; PAPPQ, CPAP perception questionnaire; PSG, polysomnogram; PSQI, Pittsburgh sleep quality index; SlePT, Sleep Pediatric Transition; UHN, University Health Network.

Role of Sponsor

The study sponsor had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

Grant Support

This study was funded by Physicians’ Service Incorporated Foundation grant number 16–29.

Author Contributions

C.R. is the guarantor of the article, taking responsibility for the integrity of the work as a whole, from inception to published article. C.R., I.N. and T.K. conceptualized, designed and obtained funding for the study. A.H., U.M., C.G.C. participated in data collection and conducted the study. T.K. performed data analysis. C.R., I.N. and T.K wrote the manuscript. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

I Narang has consulted for Bayer and is supported by the PSI foundation. C. Ryan reports grants from Physicians’ Service Incorporated Foundation, personal fees from Breso-Tec, during the conduct of the study. T. Kendzerska is supported by the PSI foundation and received a speaker honorarium from AstraZeneca Canada Inc. The authors report no other conflicts of interest in this work.