Impact of COVID-19 pandemic on adherence to noninvasive ventilation in children

Abstract

Study objectives: The aim of this study was to measure changes in adherence to noninvasive ventilation (NIV) in children during the first year of the COVID-19 pandemic.

Methods: Retrospective chart review of children (0-18 years) using home NIV through the Stollery's Pediatric NIV program in Edmonton, Canada during March 2019 to March 2021. Demographics, clinical characteristics, and adherence information from machine downloads were collected prior to and during the first year of the COVID-19 pandemic. Paired t tests and Chi-square compared adherence prepandemic and during pandemic and repeated analysis of variance tests compared adherence pre- and 0-6 and 6-12 months during pandemic.

Results: Eighty-two children met inclusion criteria (62% male; age 8.6 ± 4.6 years). Overall, there were no changes in NIV adherence during pandemic (average NIV minutes pre- and during pandemic of 390 ± 219 and 405 ± 300 minutes, respectively). When separated into increased vs decreased adherence groups, adherence differences pre- compared to during pandemic became significant, with no differences across demographic/clinical variables or prepandemic adherence. There were no changes in NIV adherence during the initial 6 months of pandemic compared to prepandemic, but NIV use significantly increased by 9-57 minutes during the following 6-12 months. Bilevel positive airway users had longer NIV use than continuous positive airway pressure users at all time points, with an overall increasing trend over time.

Conclusions: Despite the significant life disruption created by COVID-19 and changes to virtual care, children using home NIV maintained adequate adherence. Qualitative research is needed to understand the nuances of using NIV during the pandemic and potential advantages of virtual care for support of these children and families.

Citation: Halperin H, Chalifour M, Bedi PK, et al. Impact of COVID-19 pandemic on adherence to noninvasive ventilation in children. J Clin Sleep Med. 2023;19(1):179-188.

Keywords: COVID-19; adherence; compliance; noninvasive ventilation; pediatrics; sleep.

Figure 1. Flowchart description of patients included in study population and selection procedure.

Figure 2. Average NIV minutes per night (all days) at 0–12 months prepandemic and 0–6 months and 6–12 months during COVID-19 pandemic. NIV = noninvasive ventilation

A significant pairwise difference was noted with between 9 and 57 extra minutes of average NIV use from 0–6 months to 6–12 months during COVID-19 pandemic (repeated test ANOVA and post-hoc pairwise comparison–Bonferroni correction was used; F 3.975, P = .036). ANOVA = analysis of variance, NIV = noninvasive ventilation.

Figure 3. Average noninvasive ventilation minutes per night (all days) at 0–12 months prepandemic, 0–6 months during COVID-19, and 6–12 months during COVID-19 pandemic in BPAP and CPAP users.

Children on BPAP had 58–316 more minutes of therapy use at all time points compared to children using CPAP (repeated test ANOVA was used; F = 19.9346, DFn = 1, DFd = 58, P = .00004). BPAP users had a significantly increasing trend vs no changes over time in CPAP users (repeated test ANOVA was used; F 4.57, DFn = 1.56, DFd = 90.31 P = .02). ANOVA = analysis of variance, BPAP = bilevel positive airway pressure, CPAP = continuous positive airway pressure, DFd = degrees of freedom of the denominator, DFn = degrees of freedom of the numerator, NIV = noninvasive ventilation.

Figure 4. Average NIV minutes per night (all days) at 0–12 months prepandemic, 0–6 months during COVID-19, and 6–12 months during COVID-19 pandemic in prepandemic adherence and nonadherent groups.

Prepandemic nonadherent children had overall lower NIV use than previously adherent children (repeated test ANOVA was used; F 74.1836, DFn = 1, DFd = 58, P = .0000). However, there were no significant changes over time neither in the prepandemic nonadherent group. ANOVA = analysis of variance, DFd = degrees of freedom of the denominator, DFn = degrees of freedom of the numerator, NIV = noninvasive ventilation.