Sleep & breathing = Schlaf & Atmung · 2026
A novel age-based physiological definition of adherence to pediatric long-term non-invasive ventilation: an exploratory study.
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Leske V, Dicembrino M
Аннотация
INTRODUCTION: The indications for pediatric long-term non-invasive ventilation (LT-NIV) have expanded. However, a standardized definition of pediatric adherence is lacking.
OBJECTIVES: To propose a novel physiological definition of adherence to pediatric LT-NIV and compare it with the two commonly used adult-derived definitions.
METHODS: Retrospective cross-sectional study including all eligible children aged 0.15-18 years enrolled in the LT-NIV follow-up program at Hospital Garrahan, Argentina. Clinical data were obtained from medical records and adherence from device memory downloads. The proposed definition classified patients as "adherent" when LT-NIV use reached ≥ 70% of the minimum age-specific recommended sleep duration (American Academy of Sleep Medicine consensus) on ≥ 70% of nights, replacing a fixed threshold with one tailored to each child´s sleep needs. This was compared to the current(≥ 4 h/night on ≥ 70% of nights) and classic (≥ 4 h/night on ≥ 50% of nights) adult-derived definitions.
RESULTS: Eighty patients were included (median age 9.01years, IQR 5.96-14.09). The most frequent diagnoses were neuromuscular (31%) and genetic disorders (15%). LT-NIV was initiated electively in 91%, 75% reported sleep-disordered breathing symptoms, polysomnography was abnormal in 95.2%. Adherence rates were 66.25% (novel definition); 83.75% (classic definition) and 78.75% (current definition), p = 0.0005 and p = 0.0039 respectively. Poorer adherence was associated with younger age, developmental delay, absence of symptoms, earlier ventilation initiation and lower pressure settings.
CONCLUSIONS: Our results highlight an overestimation of adherence when adult definitions are used. This first study explores a novel pediatric adherence definition for LT-NIV. Our research calls for action to discuss new international pediatric adherence thresholds.
OBJECTIVES: To propose a novel physiological definition of adherence to pediatric LT-NIV and compare it with the two commonly used adult-derived definitions.
METHODS: Retrospective cross-sectional study including all eligible children aged 0.15-18 years enrolled in the LT-NIV follow-up program at Hospital Garrahan, Argentina. Clinical data were obtained from medical records and adherence from device memory downloads. The proposed definition classified patients as "adherent" when LT-NIV use reached ≥ 70% of the minimum age-specific recommended sleep duration (American Academy of Sleep Medicine consensus) on ≥ 70% of nights, replacing a fixed threshold with one tailored to each child´s sleep needs. This was compared to the current(≥ 4 h/night on ≥ 70% of nights) and classic (≥ 4 h/night on ≥ 50% of nights) adult-derived definitions.
RESULTS: Eighty patients were included (median age 9.01years, IQR 5.96-14.09). The most frequent diagnoses were neuromuscular (31%) and genetic disorders (15%). LT-NIV was initiated electively in 91%, 75% reported sleep-disordered breathing symptoms, polysomnography was abnormal in 95.2%. Adherence rates were 66.25% (novel definition); 83.75% (classic definition) and 78.75% (current definition), p = 0.0005 and p = 0.0039 respectively. Poorer adherence was associated with younger age, developmental delay, absence of symptoms, earlier ventilation initiation and lower pressure settings.
CONCLUSIONS: Our results highlight an overestimation of adherence when adult definitions are used. This first study explores a novel pediatric adherence definition for LT-NIV. Our research calls for action to discuss new international pediatric adherence thresholds.