Nature and Science of Sleep (Feb 2022)
Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care
Abstract
Indra Narang,1,2,* Tetyana Kendzerska,3,4,* Austin Heffernan,5 Uzair Malik,6 Carolina G Carvalho,7 Clodagh M Ryan8,9 1Department of Pediatrics, University of Toronto, Toronto, Canada; 2The Hospital for Sick Children, Toronto, Canada; 3Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; 4The Ottawa Hospital Research Institute, Ottawa, Canada; 5UBC, Faculty of Medicine, Vancouver, Canada; 6RCSI University of Medicine and Health Sciences, Dublin, Ireland; 7University Health Network; 8Department of Medicine, University of Toronto, Toronto, Canada; 9Sleep Research laboratory, KITE-UHN*These authors contributed equally to this workCorrespondence: Clodagh M Ryan, 9N-967 Toronto General Hospital, 585 University Ave., Toronto, Ontario, M5G 2N2, Canada, Email [email protected]: 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
