0888 Adherence to Non-Invasive Ventilatory Support in Neurodiverse Children with Sleep Disordered Breathing

Abstract Introduction In January 2024, our sleep center established a respiratory therapist (RT) driven clinic to improve adherence to non-invasive mode of ventilation (NIV) in children with sleep disordered breathing (SDB), predominantly focusing on neurotypical (NT) children. In 2025, we expanded our focus to address adherence challenges in our neurodiverse (ND) children. Methods Patients were followed at 4-week intervals for at least 3 visits and then on set intervals based on their progress. Desensitization plans were individualized to the child’s needs (mask or pressure acceptance) and routine. Our database included demographics, number of RT clinic visits, adherence based on insurance compliance requirement versus average number of hours of use per night. Severe obstructive sleep apnea (SOSA) was defined as apnea-hypopnea index of more than 10 events/hour. Results 74 patients (males 34, females 40; ages ranging from 7 months to 21 years) were seen in our clinic. There were 42 patients in the NT group and 32 patients in the ND group. Trisomy 21 was the most common co-morbidity in the ND group. Total number of RT visits was 166 (92 for NT; 74 for ND). In the NT group, 21 (50%) were adherent and 21 (50%) were non-adherent. In the ND group, 22 (68.7%) were adherent and 10 (31.3%) were non-adherent. Among the adherent NT group, average number of visits was 1.04 visits (range 1-5 visits); among the adherent ND group, average number of visits was 2.31 (range 1 to 6 visits). In the NT group, 20 (47.6%) patients had SOSA and 12 (60%) were adherent. In the ND group, 19 (59.3%) patients had SOSA and 13 (68.4%) were adherent. Two ND patients were successfully desensitized but did not achieve adherence. Conclusion In our center, ND children achieved better compliance with NIV compared to NT children but required twice the number of RT visits to achieve compliance. OSA severity did not affect adherence between the groups. In our experience, caregivers of ND group were more willing to implement and modify routines to improve adherence. We aim to further explore the potential modifiable factors in our future studies to improve adherence across both groups. Support (if any)