0749 Personalized PAP Approaches In Children Based On Clustering Of Usage Patterns
Miriam Weiss, Sasikumar Kilaikode, D Garraway, Rosemary Megalaa, Geovanny F. Pérez, Gustavo Niño · SLEEP · 2018
Compliance with Positive Airway Pressure (PAP) therapy is currently evaluated based on the number of hours used per night. Usually an average of <4hrs is considered non-adherence in adults. However, obstructive sleep apnea (OSA) in children is highly heterogeneous and this approach may not fit all age groups. This study aimed to define PAP usage patterns in children using clustering analysis of PAP compliance data. Cross-sectional study of children (0-20yrs) on PAP therapy in the Sleep Center of Children’s National in Washington D.C. We used hierarchical clustering (Ward’s method) integrating mean usage time in “all days” and “usage days only” followed by post-clustering comparisons of clinical variables. A total of 89 children were included in this study. Hierarchical clustering resulted in a three-cluster best-fit model with distinct PAP usage patterns. Cluster 1 (n=33) was characterized by low usage (<2hrs all days and <4hrs days used), high rates of residual severe OSA and universal report of mask removed at home. Cluster 2 (n=39) was characterized by intermediate (<6hrs all days) but inconsistent PAP use, particularly in obese children and in individuals on high pressures despite no residual severe OSA. Cluster 3 (n=17) was characterized by high and consistent usage (≥6hrs in all days) and the lowest rates of residual severe OSA. PAP compliance in children is heterogeneous and should not be evaluated based on the average hours used per night only (e.g. 4hrs). Our data suggest that a more appropriate initial milestone of 2hrs (all days) or 4hrs (days used) identifies clusters of low vs. intermediate usage that may need different interventions (e.g. mask desensitization vs. titration). An advanced milestone in pediatric PAP therapy that correlates with consistent use and adequate OSA control is ≥6hrs in all days and thus identifies candidates for interventions that may decrease healthcare utilization (e.g. telemedicine). Longitudinal studies are needed to define the dynamics of these pediatric PAP clusters of usage overtime across different developmental stages and thus optimize and personalize current clinical practice in pediatric PAP therapy. Support (If Any):