LAUSR

Background There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. Research Question Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? Study Design and Methods Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. Results Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17–18), median BMI was 30.3 (IQR: 24.0–37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8–30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3–8.0) vs 2.6 hours/day (0.0–6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of −1.14; 95% CI −2.27 to −0.01. Interpretation Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.