CHARLOTTE, NC — Positive airway pressure (PAP) machines have been helpful enough for pediatric patients to see their symptoms improve even without being compliant, according to researchers advocating for greater access to this therapy for this population.
In one center’s sleep clinic, 172 of 221 children with obstructive sleep apnea (OSA) reported improvement in symptoms approximately 3 months after PAP onset, and 81 of 90 had better symptoms between 1 ,5, and 2, Supriya Jambhekar, MD, of Arkansas Children’s Hospital in Little Rock, and colleagues, reported at SLEEP 2022, a joint meeting of the American Academy of Sleep Medicine and Sleep Research Society.
Notably, the improvements were not dependent on the children meeting an insurer’s standard PAP membership threshold (at least 4 hours per night for 70% of paid nights). Of those who reported improvement in symptoms after 3 months of PAP use and had sufficient data on adherence, approximately 56% had been non-adherent; similarly, about 49% of those with improvements over 2 years were found to be non-adherent, according to Jambhekar’s group reported in a separate presentation.
Symptoms particularly relevant to children with OSA included decreased concentration, hyperactivity, memory impairment, learning disabilities, bedwetting and growth retardation. These “improved with PAP and are important indicators in this population of improved clinical outcomes,” according to the authors.
“Because of the clinically meaningful growth and development outcomes that PAP provides for pediatric patients with OSA, we suggest that they should not be held to the same insurance requirements as adults and other studies be carried out to validate these results”, they insisted.
The favorable results for PAP in children come at a time when sleep research is criticized for its inconsistencies and reliance on surrogate measures instead of more clinically meaningful outcomes (e.g., all-cause mortality , stroke, myocardial infarction). Prompted by the Centers for Medicare & Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ) conducted a review and published a disorganized in 2021 stating that the available evidence does not support continuous PAP (CPAP) having an effect on long-term clinical outcomes, although further studies are needed.
Jambhekar’s group noted that there were no pediatric studies included in the AHRQ report. Moreover, when the report came out, sleep experts maintained MedPage today that CPAP remains an effective treatment for sleep-related outcomes, even if compliance is an issue.
Currently, CMS and other insurers may deny payment for PAP therapy if there is no evidence of adequate use.
For their two posters, the authors reviewed the records of 235 children with OSA (64% boys; mean age 12 years at onset of PAP). This was a predominantly white (51.5%) or African American (38.3%) group. More than half of the children suffered from obesity and their apnea-hypopnea index averaged 24.7/hour.
A limitation of the retrospective studies was the quantity of missing data: only 138 children had observance data at 3 months, falling to 74 children at 18 months-2 years.
Jambhekar and his co-authors have disclosed no relationship with the industry.