Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis

Henrietta Blinder; Franco Momoli; Julia Bokhaut; Vanessa Bacal; Reuben Goldberg; Dhenuka Radhakrishnan; Sherri L Katz

doi:10.1016/j.sleep.2019.12.015

Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis

Sleep Med. 2020 May:69:19-33. doi: 10.1016/j.sleep.2019.12.015. Epub 2020 Jan 11.

Authors

Henrietta Blinder¹, Franco Momoli², Julia Bokhaut³, Vanessa Bacal⁴, Reuben Goldberg⁵, Dhenuka Radhakrishnan⁶, Sherri L Katz⁷

Affiliations

¹ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada. Electronic address: hblin077@uottawa.ca.
² Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada. Electronic address: fmomoli@uottawa.ca.
³ Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. Electronic address: jbokhaut@cheo.on.ca.
⁴ School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; Department of Obstetrics and Gynecology, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. Electronic address: vbaca078@uottawa.ca.
⁵ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Department of Family Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. Electronic address: reuben.l.goldberg@gmail.com.
⁶ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; ICES uOttawa, Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada. Electronic address: dradhakrishnan@cheo.on.ca.
⁷ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. Electronic address: skatz@cheo.on.ca.

PMID: 32045851
DOI: 10.1016/j.sleep.2019.12.015

Abstract

Background: While positive airway pressure (PAP) is effective for treating sleep-disordered breathing (SDB) in children, adherence is poor. Studies evaluating predictors of PAP adherence have inconsistent findings, and no rigorous reviews have been conducted. This systematic review aims to summarize the literature on predictors of PAP therapy adherence in children.

Methods: Studies evaluating baseline predictors of PAP therapy adherence in children (≤20 years) with SDB were included. We searched MEDLINE, Embase, CENTRAL, CINAHL, Clinicaltrials.gov, and the last four years of conference abstracts. Results were described narratively, with random-effects meta-analyses performed where feasible. Risk of bias and confidence in the evidence were assessed.

Results: We identified 50 factors evaluated across 28 studies (21 full text articles, seven abstracts). The highest rates of PAP therapy adherence were most consistently found with female sex, younger age, Caucasian race, higher maternal education, greater baseline apnea-hypopnea index (AHI), and presence of developmental delay. Pooled estimates included odds ratios of 1.48 (95%CI: 0.75-2.93) favoring female sex, 1.26 (95%CI: 0.68-2.36) favoring Caucasian race, and a mean difference in AHI of 4.32 (95%CI: -0.61-9.26) events/hour between adherent and non-adherent groups. There was low quality evidence to suggest that psychosocial factors like health cognitions and family environment may predict adherence.

Conclusion: In this novel systematic review, we identified several factors associated with increased odds of PAP therapy adherence in children. These findings may help guide clinicians to identify and support children less likely to adhere to PAP therapy and should be considered when developing interventions to improve adherence.

Keywords: Adherence; Pediatric; Positive airway pressure; Predictor; Sleep-disordered breathing.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Age Factors
Child
Continuous Positive Airway Pressure / instrumentation*
Humans
Sex Factors
Sleep Apnea Syndromes / therapy*
Treatment Adherence and Compliance / psychology*