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Clinical predictors of non-adherence to positive airway pressure therapy in children: a retrospective cohort study

Predictors of PAP non-adherence identified in the pediatric literature to date have had limited utility for clinicians aiming to improve PAP therapy adherence rates in their clinical practice, in part due to lack of replicability across studies and methodological

shortcomings such as small sample sizes, cross-sectional assessments of adherence, and exclusion of participants with missing data. Furthermore, there is limited literature evaluating independent associations between baseline characteristics and PAP therapy non-adherence. To the best of our knowledge, this larger cohort study is the first to estimate the adjusted RRs of PAP non-adherence at 6 months for a large set of baseline

characteristics of children prescribed PAP therapy. Our study found that after adjusting for all other variables and considering potential for overfitting, the characteristics most likely to be independently associated with greater PAP therapy non-adherence  were older age and higher oxygen saturation nadir (ie, less-severe oxygen desaturations), whereas those most likely associated with lower non-adherence were higher arousal

index, developmental delay, and asthma.


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