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

Age Factors Child Continuous Positive Airway Pressure / instrumentation Humans Sex Factors Sleep Apnea Syndromes / therapy Treatment Adherence and Compliance / psychology
Adherence Pediatric Positive airway pressure Predictor Sleep-disordered breathing

Journal

Sleep medicine
ISSN: 1878-5506
Titre abrégé: Sleep Med
Pays: Netherlands
ID NLM: 100898759

Informations de publication

Date de publication:
05 2020
Historique:
received: 26 07 2019
revised: 20 12 2019
accepted: 21 12 2019
pubmed: 12 2 2020
medline: 10 4 2021
entrez: 12 2 2020
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.sleep.2019.12.015 PMID: 32045851
pubmed: 32045851
pii: S1389-9457(20)30002-2
doi: 10.1016/j.sleep.2019.12.015
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

19-33

Informations de copyright

Copyright © 2020. Published by Elsevier B.V.

Auteurs

Henrietta Blinder (H)

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.

Franco Momoli (F)

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.

Julia Bokhaut (J)

Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. Electronic address: jbokhaut@cheo.on.ca.

Vanessa Bacal (V)

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.

Reuben Goldberg (R)

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.

Dhenuka Radhakrishnan (D)

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.

Sherri L Katz (SL)

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.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Facteurs âges › Predictors of adherence to positive airway...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Predictors of adherence to positive airway...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation à pression positive › Ventilation en pression positive continue › Predictors of adherence to positive airway...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Predictors of adherence to positive airway...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Facteurs sexuels › Predictors of adherence to positive airway...
questionsmedicales.fr › Maladies du système nerveux › Syndromes d'apnées du sommeil › Predictors of adherence to positive airway...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude envers la santé › Adhésion et observance thérapeutiques › Predictors of adherence to positive airway...