Monitoring advised for children, teens with Down syndrome using positive airway pressure

Key takeaways:

• Positive airway pressure device compliance decreased between 30 days after a clinic visit and 90 days.
• Researchers recommend supportive care for children and teens with Down syndrome using these devices.

WASHINGTON — Positive airway pressure device compliance went down 90 days after a clinic visit among patients with Down syndrome, according to an abstract presented at the American Thoracic Society International Conference.

“Obstructive sleep apnea (OSA) is highly prevalent in individuals with Down syndrome,” Rakesh Bhattacharjee, MD, associate professor of pediatrics at University of California, San Diego, and colleagues wrote. “In children, upper airway surgery is mainstay for OSA treatment; however, in Down syndrome, OSA is often refractory to surgery, leading many patients to be prescribed positive airway pressure therapy (PAP). The overall efficacy of PAP in Down syndrome is poorly understood.”

In a cross-sectional retrospective review, Bhattacharjee and colleagues analyzed 47 patients (mean age, 17.7 years; 44% female; 65% Hispanic; BMI, 24.63 kg/m²) with Down syndrome from Rady Children’s Hospital using PAP therapy to observe the level of compliance (device use for 4 hours or more) and usage 30 and 90 days after a clinic visit in this patient population.

Researchers accessed Airview or Care Orchestrator to obtain patients’ cloud-based data, according to the abstract.

More than half of the patients (57%; n = 27) received PAP through CPAP devices, whereas 32% (n = 15) received it through automatic PAP and 11% (n = 5) received it through Bilevel PAP.

At day 30, researchers found that compliance was “modest” at 56.7%, but when checked again at the 90-day mark, it went down to 34.4% (P < .05).

On the other hand, the percentage of nights where PAP devices were used was comparable at day 30 (58.2%) and day 90 (62%), according to the abstract.

When assessing how cloud-based measures of expiratory positive airway pressure (EPAP), residual apnea hypopnea index and median device leak were associated with compliance, researchers found a significant relationship between EPAP and compliance at day 30 (P = .046). No additional significant associations were observed when evaluating these device data.

Further, there was no significant impact on compliance when considering demographic factors such as age, sex and ethnicity, according to the abstract.

“The findings imply that supportive care including regular monitoring of PAP device downloads and close clinical follow up is warranted for this unique population,” Bhattacharjee and colleagues wrote.