Positional obstructive sleep apnea in children prescribed continuous positive airway pressure therapy for obstructive sleep-disordered breathing

Positional obstructive sleep apnea, in which there is a ≥ 2:1 predominance of obstructive events in the supine position, is a sleep-disordered breathing phenotype with a targeted treatment in the form of positional device therapy. We sought to determine the prevalence of positional obstructive sleep apnea in a cohort of children prescribed continuous positive airway pressure therapy, ascertain risk factors for the condition, and determine the associated continuous positive airway pressure treatment adherence rate. A retrospective cohort study of all children > 2 years old from a single tertiary paediatric centre prescribed continuous positive airway pressure therapy over an 8-year period was conducted. Positional obstructive sleep apnea prevalence was established by analysing positional and respiratory event data from the participants' original diagnostic polysomnography. Continuous positive airway pressure therapy adherence was determined using data from machine download. Univariable and multivariable logistic regression modelling was used to determine participant demographic and clinical factors associated with positional obstruction. Positional obstructive sleep apnea (defined by Bignold's criteria modified for paediatric use) prevalence in the cohort of 237 analysed participants was 38%. Suboptimal continuous positive airway pressure adherence was noted in 30% of this group based on initial machine download, performed a median of 96 days post-treatment initiation. Higher age and lower obstructive apnea-hypopnea index were independent predictors of positional obstructive sleep apnea, whereas neurodevelopmental diagnosis, presence/absence of rapid eye movement-related obstructive sleep apnea, overweight/obesity status and history of adenoidectomy/adenotonsillectomy were not. For children, positional device therapy is a treatment option worthy of further consideration and research.