Predictors of Non-Adherence to Positive Airway Pressure Therapy in Children

Abstract

In children with sleep-disordered breathing, adherence to positive airway pressure (PAP) therapy is poor. Literature on predictors of PAP non-adherence is limited by lack of rigorous reviews and inconsistent findings across studies. This thesis aimed to address this dearth of information through both a systematic review and a retrospective cohort study. Our review summarized the literature on predictors of non-adherence in children, including identifying common methodological concerns. These results informed the development of our cohort study, which identified clinical predictors of PAP non-adherence at six months. Overall, we identified that non-adherence was greater in children of older age, without developmental delay or asthma, with lower baseline apnea-hypopnea index, less low oxygen saturation nadir, lower arousal index, and lower maternal education. Ultimately, this thesis provides a foundation to help clinicians prioritize limited resources towards children requiring more support to succeed with PAP therapy adherence, before negative long-term habits of non-adherence form.