Defining the patterns of PAP adherence in pediatric obstructive sleep apnea: a clustering analysis using real-world data

Weiss, Miriam; Allen, Michelle; Landeo‐Gutierrez, Jeremy; Lew, Jenny; Aziz, Julia; Mintz, Sylvan S.; Lawlor, Claire M.; Becerra, Benjamin J.; Preciado, Diego; Niño, Gustavo

doi:10.5664/jcsm.9100

Cited by 14 publications

(11 citation statements)

References 34 publications

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“…In this case, although CPAP therapy was not well tolerated initially, tolerance of CPAP therapy can be influenced by a variety of underlying factors. 25 Cheng et al reported six cases with RS where CPAP treatment failed due to severe airway obstruction, and highlighted the need to evaluate for additional airway problems that require more complex surgery in these cases. 4 In our third case, with maturation and in the presence of documented improvement in the severity of airway obstruction, the infant was able to tolerate a later period of home CPAP therapy.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Change in the Severity of Airway Obstruction with Robin Sequence in Early Infancy

Dede

Robinson

Castro

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Previous studies suggest that infants with Robin sequence show a pattern of steady improvement in the severity of airway obstruction, and of their treatment requirements, during infancy. Methods: Three infants with Robin sequence and severe obstructive sleep apnea were managed with nasal continuous positive airways pressure (CPAP). Multiple measures of airway obstruction were made during infancy, including CPAP pressure evaluations and sleep studies (screening and polysomnography studies). Parameters reported include obstructive apnea-hypopnea index, oxygen desaturation parameters, and CPAP pressures required for effective airway management. Results: CPAP pressure requirements increased in all three infants during their first weeks of life. Apnea indices on polysomnography did not track with the CPAP pressure requirements. Peak pressure requirements were at 5 and 7 weeks for two patients, with subsequent gradual decline and cessation of therapy CPAP at 39 and 74 weeks, respectively. The third patient had a complicated course, jaw distraction at 17 weeks, and biphasic CPAP pressure requirement (first peak at 3 weeks, but maximum pressure at 74 weeks), with cessation of CPAP at 75 weeks. Conclusions: The observed pattern of early increases in CPAP pressure requirements for infants with Robin sequence adds to the complexities of managing this disorder. Factors that may lead to this pattern of change in airway obstruction are discussed.

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Section: Discussionmentioning

confidence: 99%

Patterns of Change in the Severity of Airway Obstruction with Robin Sequence in Early Infancy

Dede

Robinson

Castro

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…This personalized cluster approach may be possible to target PAP therapy optimization at an individualized level. While this study shows promise, additional validation with more extensive longitudinal studies is needed 66 …”

Section: Remote Monitoring and Utility Of Big Data In Monitoring Pap Usementioning

confidence: 94%

“…Since acceptance, response, and adherence to PAP therapy can be heterogeneous in the pediatric population; tailored interventions may be required to optimize adherence using these remote monitoring capabilities. Weiss et al 66 retrospectively examined cloud‐based PAP therapy data in 250 children, and by using a novel method of cluster analysis, they created subgroups based on PAP tolerance (average hours of PAP use on days used) and consistency of PAP use (percentage of days used during the recording period). The cohort was classified into five clusters (A, B, C, D, and E), representing best PAP tolerance and consistent use (cluster A), acceptable PAP tolerance and consistent use (cluster B), poor tolerance to PAP therapy but relatively consistent use (cluster C), acceptable PAP tolerance and inconsistent use (cluster D) and poor PAP tolerance and inconsistent use (cluster E).…”

Section: Remote Monitoring and Utility Of Big Data In Monitoring Pap Usementioning

confidence: 99%

“…While this study shows promise, additional validation with more extensive longitudinal studies is needed. 66 Remote monitoring can also offer increased access to patients, especially those living hours away from a children's hospital or specialist. In addition to monitoring for adherence, home monitoring can be helpful to clinically assess a patient's status and determine if more or less support is indicated depending on their changing needs.…”

Section: Remote Monitoring and Utility Of Big Data In Monitoring Pap Usementioning

confidence: 99%

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Pediatric pulmonary year in review 2021: Sleep medicine

Okorie

Afolabi‐Brown

Tapia

2022

Pediatric Pulmonology

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Pediatric pulmonology publishes original research, review articles, and case reports on a wide variety of pediatric respiratory disorders. In this article, we summarized the past year's publications in sleep medicine and reviewed selected literature from other journals in this field. We focused on original research articles exploring aspects of sleep‐disordered breathing in patients with underlying conditions such as cystic fibrosis, asthma, and sickle cell disease. We also explored sleep‐disordered breathing risk factors, monitoring, diagnosis, and treatment; and included recent recommendations for drug‐induced sleep endoscopy and ways to monitor and improve PAP adherence remotely.

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“…Acceptance of this form of therapy can be a significant challenge, with recent evidence confirming that adherence is generally poor. WEISS et al [50] used statistical cluster analysis to examine clinical characteristics and adherence measures for paediatric CPAP patients. Fewer than half of the children were consistently using CPAP for >4 h a night (the level identified in adult literature as bringing tangible gains).…”

Section: Adenotonsillectomymentioning

confidence: 99%

Recent advances in paediatric sleep disordered breathing

Garde

Gibson

Samuels

et al. 2022

Breathe

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This article reviews the latest evidence pertaining to childhood sleep disordered breathing (SDB), which is associated with negative neurobehavioural, cardiovascular and growth outcomes. Polysomnography is the accepted gold standard for diagnosing SDB but is expensive and limited to specialist centres. Simpler tests such as cardiorespiratory polygraphy and pulse oximetry are probably sufficient for diagnosing obstructive sleep apnoea (OSA) in typically developing children, and new data-processing techniques may improve their accuracy. Adenotonsillectomy is the first-line treatment for OSA, with recent evidence showing that intracapsular tonsillectomy results in lower rates of adverse events than traditional techniques. Anti-inflammatory medication and positive airway pressure respiratory support are not always suitable or successful, although weight loss and hypoglossal nerve stimulation may help in select comorbid conditions.Educational aimsTo understand the clinical impact of childhood sleep disordered breathing (SDB).To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.

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Defining the patterns of PAP adherence in pediatric obstructive sleep apnea: a clustering analysis using real-world data

Cited by 14 publications

References 34 publications

Patterns of Change in the Severity of Airway Obstruction with Robin Sequence in Early Infancy

Patterns of Change in the Severity of Airway Obstruction with Robin Sequence in Early Infancy

Pediatric pulmonary year in review 2021: Sleep medicine

Recent advances in paediatric sleep disordered breathing

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