Issue Navigator

Volume 15 No. 06
Earn CME
Accepted Papers

Scientific Investigations

Adherence to Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea in Children With Developmental Disabilities

Eun Kyeong Kang, MD1,2; Melissa S. Xanthopoulos, PhD1; Ji Young Kim, PhD1,3; Casandra Arevalo, MD1; Justine Shults, PhD1; Suzanne E. Beck, MD1,4; Carole L. Marcus, MBBCh1,4; Ignacio E. Tapia, MD1,4
1Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 2Dongguk University College of Medicine, Seoul, South Korea; 3Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 4Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Study Objectives:

To determine whether adherence to positive airway pressure (PAP) differs in children with developmental disabilities (DD) compared to typically developing (TD) children.


PAP adherence of 240 children initiated on PAP for obstructive sleep apnea (OSA) was retrospectively analyzed. Adherence between groups, expressed as percentage of nights used and hours of usage on nights used at 3 and 6 months, was compared. Predictive factors of adherence were studied using a median regression model.


A total of 103 children with DD (median [interquartile range] age = 7.9 [3.2–13.1] years) and 137 TD (11.0 [5.5–16.1], P = .005) children were included. Percentage of nights used was significantly higher in children with DD at 3 (DD = 86.7 [33.9–97.9], TD = 62.9 [30.8–87.8] P = .01) and 6 months (DD = 90.0 [53.3–100], TD = 70.7 [29.2–90.8], P = .003). Hours of usage on nights used at 3 and 6 months were similar between groups (DD = 5.0 [1.4–7.9], TD = 4.6 [1.9–7.2], P = .715; DD = 6.4 [1.8–8.3], TD = 5.7 [2.5–7.3], P = .345, respectively). This adherence measure improved over time in both groups (DD, P = .007; TD, P = .005). At 6 months, higher median neighborhood income and titration at or before 6 months were significantly predictive for percentage of nights used; higher PAP pressure was significantly predictive for hours of usage in both groups.


Children with DD had better PAP adherence expressed as percentage of nights used than TD children. Hours of usage on nights used at 3 and 6 months were similar between groups and improved over time. Higher income and titration at or before 6 months were predictive of adherence in all children. These findings indicate that children with DD can successfully wear PAP.


Kang EK, Xanthopoulos MS, Kim JY, Arevalo C, Shults J, Beck SE, Marcus CL, Tapia IE. Adherence to positive airway pressure for the treatment of obstructive sleep apnea in children with developmental disabilities. J Clin Sleep Med. 2019;15(6):915–921.

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.