Outcomes of home positive airway pressure (PAP) in management of obstructive sleep apnoea in a paediatric unit in Hong Kong SAR

Abstract

Aim: To study the characteristics of paediatric patients who have initiated nocturnal Positive Airway Pressure (PAP) for treatment of OSAS and to assess the outcomes of PAP therapy. Methods: Retrospective review of clinical data of patients aged 1 month to 18 years initiated PAP for treatment for OSAS in the paediatric unit of a public hospital in Hong Kong. Treatment outcomes of polysomnographic parameters and symptoms pre- and post- therapy were analysed and patient’s adherence was evaluated. Results: Forty-five patients initiated PAP during January 2009 to December 2016 were included. There was increasing number of patients being initiated on PAP therapy for treatment of OSAS over the years. The study population was predominantly males with two-thirds more than 12 years old. Craniofacial or syndromal conditions were mostly present in young children less than 5 years old while obesity was more common in adolescents. Of the treated patients, 75.6% had allergic rhinitis. Comparing symptoms before and within 6 months after PAP trial, there were significantly less patients with complaints of habitual snoring (95.6% vs 8.9%, p<0.01) and excessive daytime sleepiness (42.2% vs 11.1%, p<0.01). There was significant improvement in PSG parameters with mean OAHI decreased from 21.5±18.5/hour TST to 1.6±1.9/hour TST (p<0.05) and mean SpO2 (oxygen saturation) nadir increased from 80.6%±10.4% to 90.9%±5.7% (p<0.05) after PAP therapy. Within 6 months of follow up, 57.8% of the patients adhered to PAP satisfactorily while the adherence dropped to 37.8% at the time of the latest follow-up. Satisfactory usage established before 6 months was associated with favourable long-term outcomes of satisfactory usage or cessation of therapy due to improvement at the latest follow-up (chi square test p= 0.008). The commonest reported reason for non-adherence was due to nasal obstruction. Conclusion: Nocturnal PAP is an effective treatment option for OSAS especially in children with comorbid conditions. Our findings of high prevalence of co-existence allergic rhinitis and complaints of nasal obstruction warranted further investigations on management strategies to improve adherence in our local population.