Randomized, Double-Blind Clinical Trial of Two Different Modes of Positive Airway Pressure Therapy on Adherence and Efficacy in Children

Marcus, Carole L.; Beck, Suzanne E.; Traylor, Joel; Cornaglia, Mary Anne; Meltzer, Lisa J.; DiFeo, Natalie; Karamessinis, Laurie; Samuel, John; Falvo, Jennifer; DiMaria, Michelle; Gallagher, Paul R.; Beris, Heidi; Menello, Mary Kate

doi:10.5664/jcsm.1656

Cited by 90 publications

(63 citation statements)

References 23 publications

(34 reference statements)

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“…[9][10][11][12] CPAP adherence patterns of adolescents have not been extensively studied, but studies of medication adherence in other adolescent groups, such as asthmatics, epileptics, and diabetics have demonstrated poor adherence. 13,14 Poor adherence in adolescents may be related to not understanding or not perceiving the benefi ts of the treatment, wanting to conform to peers, and rebelling against authority.…”

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confidence: 99%

Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

Prashad

Marcus

Maggs

et al. 2013

Journal of Clinical Sleep Medicine

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adolescents and their caregivers. To our knowledge, this is the fi rst study focused on the adolescent age group.The purpose of the study was to identify and explore factors that infl uenced adolescent CPAP use, using a modifi ed grounded theory approach.16 Grounded theory is a qualitative method that seeks to generate theories from the data, to offer explanations for the phenomenon being explored. METHODSThis exploratory study consisted of qualitative semi-structured interviews and a download of the adolescent's adherence data from his or her CPAP machine during the previous month.Study Objectives: Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers.Methods: Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modifi ed grounded theory approach, we identifi ed themes and developed theories that explained the adolescents' adherence patterns. Results: Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefi ts were issues that played a role in CPAP adherence. Conclusions: Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our fi ndings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea syndrome (OSAS) affects approximately 2% of children and adolescents.1 OSAS in children may result in severe complications if left untreated, such as growth failure, pulmonary hypertension, neurocognitive defi cits, behavioral problems, and attention defi cit hyperactivity disorder. [2][3][4][5][6] In young children, OSAS can often be treated with adenotonsillectomy. However, in adolescents, adenotonsillectomy may not be effective, as adenoids and tonsils involute with age 7,8 and obesity is more likely to be present. While weight loss may be an effective treatment for OSAS in this age group, it is difficult to achieve and maintain, particularly for those with severe o...

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confidence: 99%

Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

Prashad

Marcus

Maggs

et al. 2013

Journal of Clinical Sleep Medicine

Self Cite

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“…[6][7][8][9] Desensitization is effective but timeconsuming, 10,11 complaints of side effects are common, 7 and the adverse effects of CPAP on a developing face are increasingly recognized. 12 Many attempts to improve tolerability and adherence of CPAP therapy have proven ineffective.…”

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confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Methods: Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Results: Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). Conclusions: High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.

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“…In the fi rst paper, Marcus and colleagues describe a randomized clinical trial in children with OSA of standard CPAP or a proprietary mode of PAP during which pressure decrements during both late inspiration and expiration were permitted. 3 There was no difference in adherence between the 2 modes after 3 months. With both modes, adherence was suboptimal, with substantial variability in hours of usage within the experimental groups.…”

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confidence: 87%