Abstract:ObjectivesThe treatment outcomes of pediatric obstructive sleep apnea (OSA) are affected by positive airway pressure (PAP) therapy adherence, which may be affected by the type of device used. Continuous PAP (CPAP) devices deliver a continuous and fixed air pressure level, whereas automatic PAP (APAP) devices automatically adjust the pressure to meet changing needs during sleep. The adherence, tolerance and consistency of OSA-children's use of CPAP and APAP devices were compared.Study designOne-year, observatio… Show more
“… 40–42 , 45 , 49 Figure 6 Calculation of obesity of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. 40 , 46 , 48 , 51 Figure 7 Calculation of income of family less than 20,000 USD of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. 41 , 45 Figure 8 Calculation of sleep efficiency (%) during polysomnography of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine.…”
Section: Resultsmentioning
confidence: 99%
“…Of these 34, 12 studies had compared those who were adherent with those who were not and had applied a meta-analysis calculation (Tables 3 and 4). [40][41][42][43][44][45][46][47][48][49][50][51] Most of the 34 studies were conducted in North America (23 of 34 studies) and had a retrospective study design (20 of 34 studies). The longest duration for CPAP adherence evaluation was four years 22 with an average duration of 10.04 (SD 9.82) months.…”
Section: Resultsmentioning
confidence: 99%
“…Additionally, another study identified non-significant higher AHI in the adherent group as well (20.5 vs 17.5 events/h; p 0.651). 51 Note that the study by Tovichien et al was not included as they reported median AHI. After totaling up, the adherent group had greater significant value than the non-adherent group.…”
Section: Discussionmentioning
confidence: 99%
“…These differences between the two meta-analysis studies may be due to more studies included in the present Figure 3 Calculation of sex of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. [40][41][42][43][44][45][46][47][48][49]51 Figure 4 Calculation of ethnicity (Caucasian) of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. [41][42][43]45 Figure 5 Calculation of body mass index (kg/m 2 ) of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine.…”
Introduction
Obstructive sleep apnea (OSA) is a public health problem that affects children. Although continuous positive airway pressure (CPAP) therapy is effective, the CPAP adherence rate in children is varied. This study aimed to evaluate the CPAP adherence rate and factors associated with CPAP adherence in children with OSA using a systematic review.
Methods
The inclusion criteria were observational studies conducted in children with OSA and assessed adherence of CPAP using objective evaluation. The literature search was performed in four databases. Meta-analysis using fixed-effect model was conducted to combine results among included studies.
Results
In all, 34 studies that evaluated adherence rate and predictors of CPAP adherence in children with OSA were included, representing 21,737 patients with an average adherence rate of 46.56%. There were 11 calculations of factors predictive of CPAP adherence: age, sex, ethnicity, body mass index, obesity, income, sleep efficiency, the apnea-hypopnea index (AHI), severity of OSA, residual AHI, and lowest oxygen saturation level. Three different factors were linked to children with adherence and non-adherence to CPAP: age, body mass index, and AHI.
Conclusion
The CPAP adherence rate in children with OSA was 46.56%. Young age, low body mass index, and high AHI were associated with acceptable CPAP adherence in children with OSA.
“… 40–42 , 45 , 49 Figure 6 Calculation of obesity of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. 40 , 46 , 48 , 51 Figure 7 Calculation of income of family less than 20,000 USD of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. 41 , 45 Figure 8 Calculation of sleep efficiency (%) during polysomnography of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine.…”
Section: Resultsmentioning
confidence: 99%
“…Of these 34, 12 studies had compared those who were adherent with those who were not and had applied a meta-analysis calculation (Tables 3 and 4). [40][41][42][43][44][45][46][47][48][49][50][51] Most of the 34 studies were conducted in North America (23 of 34 studies) and had a retrospective study design (20 of 34 studies). The longest duration for CPAP adherence evaluation was four years 22 with an average duration of 10.04 (SD 9.82) months.…”
Section: Resultsmentioning
confidence: 99%
“…Additionally, another study identified non-significant higher AHI in the adherent group as well (20.5 vs 17.5 events/h; p 0.651). 51 Note that the study by Tovichien et al was not included as they reported median AHI. After totaling up, the adherent group had greater significant value than the non-adherent group.…”
Section: Discussionmentioning
confidence: 99%
“…These differences between the two meta-analysis studies may be due to more studies included in the present Figure 3 Calculation of sex of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. [40][41][42][43][44][45][46][47][48][49]51 Figure 4 Calculation of ethnicity (Caucasian) of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine. [41][42][43]45 Figure 5 Calculation of body mass index (kg/m 2 ) of pediatric patients with obstructive sleep apnea on adherence of a continuous positive airway pressure machine.…”
Introduction
Obstructive sleep apnea (OSA) is a public health problem that affects children. Although continuous positive airway pressure (CPAP) therapy is effective, the CPAP adherence rate in children is varied. This study aimed to evaluate the CPAP adherence rate and factors associated with CPAP adherence in children with OSA using a systematic review.
Methods
The inclusion criteria were observational studies conducted in children with OSA and assessed adherence of CPAP using objective evaluation. The literature search was performed in four databases. Meta-analysis using fixed-effect model was conducted to combine results among included studies.
Results
In all, 34 studies that evaluated adherence rate and predictors of CPAP adherence in children with OSA were included, representing 21,737 patients with an average adherence rate of 46.56%. There were 11 calculations of factors predictive of CPAP adherence: age, sex, ethnicity, body mass index, obesity, income, sleep efficiency, the apnea-hypopnea index (AHI), severity of OSA, residual AHI, and lowest oxygen saturation level. Three different factors were linked to children with adherence and non-adherence to CPAP: age, body mass index, and AHI.
Conclusion
The CPAP adherence rate in children with OSA was 46.56%. Young age, low body mass index, and high AHI were associated with acceptable CPAP adherence in children with OSA.
“…Depression, anxiety, and the locus of control are all psychological problems. Last but not least, problems with the device itself, like mask leaks, skin abrasions, and nasal congestion, can make it difficult to use [24]. Adenotonsillectomy is currently, one of the first-line therapies for pediatric OSA (AT).…”
Background: Obstructive Sleep Apnea Syndrome (OSA) is a syndrome of total or partial obstruction of the airways, leading to significant disturbances with varying clinical impact. In children, the main cause is thought to be overgrowth (hypertrophy) of the tonsils and adenoids, as well as structural abnormalities in Pierre Robin and Down Syndrome. The airway structures are significantly narrowed in children with head-face bone abnormalities or craniofacial anomalies, causing them to experience airway obstruction even in the absence of adenoid hypertrophy. The incidence of OSA in children needs to be observed as well as rising risk factors such as obesity. Pediatric obstructive sleep apnea (OSA) is typically treated with an adenotonsillectomy and the use of orthodontic procedures including rapid maxillary expansion and mandibular advancement devices. Each approach has different treatment advantages. Systematic reviews and meta-analysis of OSA treatments have been reported, however there have been relatively few comparisons of various treatments. In a systematic review of the evidence for the efficacy of AT and orthodontic treatment, Templier et al. concluded that combined AT orthodontic treatment (RME and/or MAD) was more effective than either therapy alone for treating OSA in pediatric patients.
Objective: To systemically analyze the literature on the effectiveness of orthodontic treatment with adenotonsillectomy surgery in children with obstructive sleep apnea (OSA) and to identify differences in the two treatments’ effectiveness.
Conclusion and implications: The effectiveness of adenotonsillectomy, orthodontic treatment, and orthodontic treatment combined with adenotonsillectomy was assessed in children with mild OSA and mandibular retrognathia. That study, which needed a large sample size (352 children) and had a high dropout rate, revealed that combine orthodontic adenotonsillectomy (RME and/or MAD treatment) was more effective when given simultaneously than when given individually for treating OSA in pediatric patients. To date, the effectiveness of these two treatments cannot currently be compared due to a lack of strong evidence. If the treatment outcomes were unsatisfactory at 7 months after the initial treatment, subjects could receive further treatment following assessment by a stomatologist and ear, nose, and throat (ENT) specialist.
Limitations: Of the 10 publications included in this review, 8 were randomized controlled trials, the remaining 2 non-randomized research journals were vulnerable to many biases that impair the certainty of the evidence gained, especially by confounding factors and the lack of control groups.
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