Effects of positive airway pressure therapy on neurobehavioral outcomes in children with obstructive sleep apnea

Abstract

Rationale: Positive airway pressure therapy is frequently used to treat obstructive sleep apnea in children. However, it is not known whether positive airway pressure therapy results in improvements in the neurobehavioral abnormalities associated with childhood sleep apnea.

Objectives: We hypothesized that positive airway pressure therapy would be associated with improvements in attention, sleepiness, behavior, and quality of life, and that changes would be associated with therapy adherence.

Methods: Neurobehavioral assessments were performed at baseline and after 3 months of positive airway pressure therapy in a heterogeneous group of 52 children and adolescents.

Measurements and main results: Adherence varied widely (mean use, 170 ± 145 [SD] minutes per night). Positive airway pressure therapy was associated with significant improvements in attention deficits (P < 0.001); sleepiness on the Epworth Sleepiness Scale (P < 0.001); behavior (P < 0.001); and caregiver- (P = 0.005) and child- (P < 0.001) reported quality of life. There was a significant correlation between the decrease in Epworth Sleepiness Scale at 3 months and adherence (r = 0.411; P = 0.006), but not between other behavioral outcomes and adherence. Behavioral factors also improved in the subset of children with developmental delays.

Conclusions: These results indicate that, despite suboptimal adherence use, there was significant improvement in neurobehavioral function in children after 3 months of positive airway pressure therapy, even in developmentally delayed children. The implications for improved family, social, and school function are substantial. Clinical trial registered with www.clinicaltrials.gov (NCT 00458406).

Trial registration: ClinicalTrials.gov NCT00458406.

Figure 1.

The box plots show improvements in symptoms of attention-deficit/hyperactivity disorder as measured by the Conners scale (left panel) and Child Behavior Checklist (CBCL) attention scale (center panel), and changes in daytime sleepiness as measured by the Epworth Sleepiness Scale (right panel), before and after 3 months of positive airway pressure (PAP). There was a significant improvement in symptoms of attention-deficit/hyperactivity disorder and sleepiness. The box represents the interquartile ranges, which contains 50% of all values. The line across the box indicates the median. The whiskers extend from the box to the 90th and 10th percentiles, excluding outliers. Outliers (open circles) are defined as cases outside the 90th and 10th percentiles.

Figure 2.

The box plots show changes in internalizing, externalizing, and total scores on the Child Behavior Checklist (CBCL) before and after 3 months of positive airway pressure (PAP). There were significant improvements in internalizing and total behavior symptom scores, but not in externalizing symptoms. The box represents the interquartile ranges, which contains 50% of all values. The line across the box indicates the median. The whiskers extend from the box to the 90th and 10th percentiles, excluding outliers. Outliers (open circles) are defined as cases outside the 90th and 10th percentiles.

Figure 3.

The box plots show improvements in obstructive sleep apnea (OSA)–specific (left panel, as measured by the OSA-18 scale) and general health-related quality of life (center and right panels, as measured by the caregiver and child PedsQL) before and after 3 months of positive airway pressure (PAP). The box represents the interquartile ranges, which contains 50% of all values. The line across the box indicates the median. The whiskers extend from the box to the 90th and 10th percentiles, excluding outliers. Outliers (open circles) are defined as cases outside the 90th and 10th percentiles.

Figure 4.

Individual changes in Epworth Sleepiness Scale at 3 months, as a percentage of baseline, is shown on the y-axis, and positive airway pressure (PAP) adherence, reflected as mean minutes used per night, is shown on the x-axis. There was a significant correlation between PAP use and change in sleepiness.