Adherence to positive airway pressure therapy in patients with Down syndrome: assessing cloud based monitoring data

Study objectives: Obstructive sleep apnea (OSA) is common in Down syndrome (DS) with many patients prescribed positive airway pressure (PAP) therapy. This study evaluates PAP adherence and identifies factors influencing adherence.

Methods: Retrospective analysis of electronic health records and cloud-based PAP therapy data from DS patients at Rady Children's Hospital, San Diego, CA. Cloud data were evaluated cross-sectionally at 30- and 90-nights post-clinic visit and longitudinally in patients with ≥2 90-night data downloads. Outcomes included compliance (percentage of nights with ≥4 hours of use) and usage (percentage of nights with any PAP usage). The impact of demographic and PAP therapy factors (e.g., mask leak) on these outcomes was also assessed.

Results: 47 patients with DS with cloud-based PAP therapy data over a 90-night period and 46 over a 30-night period were analyzed. The mean age was 17.7±4.6 years (21 females). Median compliance was significantly higher at 30 nights (56.7%, IQR:0.0,90.8%) than at 90 nights (34.4%, IQR:0.0,86.7%) (p<0.05). Median usage did not differ between the 30-night and 90-night periods. Demographic characteristics and PAP therapy parameters were not associated with compliance or usage. Among the longitudinal cohort (n=32), median compliance was 69.7% (IQR:19.2,90.0%) and median usage was 78.2% (IQR:45.2,95.7%). Compared to an age- and sex-matched cohort without DS, patients with DS demonstrated higher PAP compliance (p<0.05).

Conclusions: Cross-sectional and longitudinal analyses reveal that many DS patients successfully adhere to PAP therapy, challenging the misconception that they struggle with adherence and proving they may be as successful, if not more, than non-DS patients.