Abstract Rationale Existing literature suggest that suboptimal adherence with non-invasive positive airway pressure therapies (NI-PAP) in children is common, particularly during the initiation period, and may disproportionately affect certain patient groups. We aimed to identify the prevalence of suboptimal adherence with NI-PAP therapy in the home mechanical ventilation (HMV) population of a large tertiary pediatric center in Western Canada and characterize barriers and protective factors to adherence. Methods A five-year retrospective chart review exploring NI-PAP adherence patterns among pediatric patients aged 2-18 years. Patient characteristics, initiation environment, patient and provider-reported barriers to adherence, and reasons for treatment discontinuation were recorded longitudinally across four time points over ≥18 months. Adherence was categorized as full, partial, or non-adherent based on published adult criteria and modified pediatric criteria. Univariate analyses investigated associations between patient characteristics, management and long-term adherence. Regression modelling characterized differences in average adherence across all time points between population subgroups. Results Eighty children were included. Median age at NI-PAP start was 10.4 years (IQR 5.9-14.4). CPAP and BPAP were equally represented. 38% had a neuromuscular disorder (NMD).Non-adherence to NI-PAP therapy was the most common reason for treatment discontinuation, accounting for 63% of cases. Common drivers for non-adherence included behavioral challenges, treatment burden, and mask discomfort.Baseline adherence strongly predicted future adherence: among 24 patients who were non-adherent at their second visit, 79% were already non-adherent at baseline and none had been fully adherent initially.Adherence was higher in children with NMD compared to genetic/syndromic diagnoses (partial vs non-adherent, p = 0.020). Probability of long-term adherence did not differ by age group or by inpatient versus outpatient initiation of NI-PAP.Univariate analysis demonstrated trends towards lower adherence among users of BiPAP compared to CPAP, lack of access to home nursing support, and residence in a remote/rural region of our province. Patient sex impacted adherence, with females more likely to be fully adherent and males partially adherent (p = 0.041).Categorization of adherence within this cohort was consistent whether pediatric-adjusted or established adult adherence definitions were applied. Conclusion Non-adherence with NI-PAP is highly prevalent in this pediatric population. Baseline adherence and clinical phenotype strongly influenced long-term NI-PAP usage patterns. Targeted early adherence support—particularly for genetic/syndromic patients and those with behavioural, home support, or equipment-related barriers—may improve sustained adherence. These findings will inform a quality improvement initiative enhancing adherence through specialized care teams, optimized follow-up, and tailored educational tools. This abstract is funded by: None
Sahasrabudhe et al. (Fri,) studied this question.