Sleep medicine · 2025
The association between insomnia, chronotype, and positive airway pressure adherence in children and adolescents.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Xiao Lena, Sarbajna Rianna, Kuyntjes Sarah, Cithiravel Nisha, Amin Reshma, Chiang Jackie, Baker Adele, Narang Indra
Аннотация
STUDY OBJECTIVES: Positive airway pressure (PAP) therapy is highly efficacious for the treatment of sleep-disordered breathing in children but is limited by poor adherence. We sought to evaluate the relationship between insomnia and chronotype on PAP adherence in children.
METHODS: This is a cross-sectional study conducted at the Hospital for Sick Children (Toronto, Canada) of children aged 4-18 years old prescribed PAP for a minimum of six months. Self-reported and/or caregiver-reported questionnaires including the Pediatric Insomnia Severity Index and Children's Chronotype Questionnaire were completed. PAP therapy usage was measured using objective download data.
RESULTS: There were 159 participants included (median age = 14.2 years, females = 38%). Median PAP usage was 436.0 min/night (IQR 147.0, 516.0) for the morning group, 417.0 min/night (IQR 189.2, 538.8) for the intermediate group, and 161.5 min/night (IQR 6.0, 405.2) for the evening group. Children with an evening chronotype used PAP therapy for a median of 264.4 min less per night than children with an intermediate chronotype (95% CI 65.8, 397.1; p = 0.0018). Children used PAP therapy for 37.0 min less per night for each 1-point increase in the sleep maintenance problems score (95% CI 10.0, 47.7; p < 0.001) and 33.7 min less per night for each 1-point increase in the sleep onset problems score (95% CI 20.0, 39.5; p < 0.001). Sleep onset and sleep maintenance problems significantly influenced the relationship between chronotype and PAP usage.
CONCLUSION: We found that insomnia and evening chronotype were associated with reduced PAP adherence in children. These may be modifiable factors to promote PAP adherence.
METHODS: This is a cross-sectional study conducted at the Hospital for Sick Children (Toronto, Canada) of children aged 4-18 years old prescribed PAP for a minimum of six months. Self-reported and/or caregiver-reported questionnaires including the Pediatric Insomnia Severity Index and Children's Chronotype Questionnaire were completed. PAP therapy usage was measured using objective download data.
RESULTS: There were 159 participants included (median age = 14.2 years, females = 38%). Median PAP usage was 436.0 min/night (IQR 147.0, 516.0) for the morning group, 417.0 min/night (IQR 189.2, 538.8) for the intermediate group, and 161.5 min/night (IQR 6.0, 405.2) for the evening group. Children with an evening chronotype used PAP therapy for a median of 264.4 min less per night than children with an intermediate chronotype (95% CI 65.8, 397.1; p = 0.0018). Children used PAP therapy for 37.0 min less per night for each 1-point increase in the sleep maintenance problems score (95% CI 10.0, 47.7; p < 0.001) and 33.7 min less per night for each 1-point increase in the sleep onset problems score (95% CI 20.0, 39.5; p < 0.001). Sleep onset and sleep maintenance problems significantly influenced the relationship between chronotype and PAP usage.
CONCLUSION: We found that insomnia and evening chronotype were associated with reduced PAP adherence in children. These may be modifiable factors to promote PAP adherence.