Pilot Study: Behavioral and Medical Clinical Partnership for Optimization of Positive Airway Pressure Therapy in Pediatric Patients

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY Pediatric neurology Pub Date : 2024-10-04 DOI:10.1016/j.pediatrneurol.2024.09.027

Emily V. Singer MD , Hayley Martins DO , Lana Boursoulian MD , Amanda Hicklin APRN , Whitney Loring PsyD , Beth A. Malow MD , Nicole Poirier APRN , Denise Smith BS , Althea Shelton MD

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Abstract

Background

To assess the effectiveness of a structured algorithm for pediatric positive airway pressure (PAP) initiation for the treatment of obstructive sleep apnea (OSA).

Methods

An algorithm was created to support pediatric PAP use and identify patients who could benefit from early behavioral consultation and education. Sleep providers implemented a unified introduction to PAP therapy with the PAP therapy toolkit. Through a collaborative approach with the medical equipment companies, pediatric patients were provided with PAP equipment before PAP titration studies and were allowed a gradual initiation of PAP therapy. PAP downloads were reviewed to determine improvements in compliance measured by percent of average days used and average minutes per night used.

Results

Thirty-eight pediatric patients completed the PAP therapy algorithm. There was significant improvement in PAP compliance in percentage of days used (paired t test P value = 0.04), as well as an improvement (although not statistically significant) in average nightly use. Patients benefitted from close follow-up visits with the sleep advanced practice providers. Patients seen for the consultation with the pediatric behavioral psychologist showed statistically significant improvement in both percentage of days and average nightly use.

Conclusions

Our pilot study shows that a behavioral and medical partnership using a structured algorithm was feasible and resulted in improved PAP compliance for our pediatric patients.

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试点研究：行为和医疗临床合作优化儿科患者的气道正压疗法

背景为了评估小儿气道正压（PAP）治疗阻塞性睡眠呼吸暂停（OSA）的结构化算法的有效性，我们创建了一种算法来支持小儿气道正压的使用，并识别可从早期行为咨询和教育中受益的患者。睡眠服务提供者利用 PAP 治疗工具包对 PAP 治疗进行统一介绍。通过与医疗设备公司合作的方式，儿科患者在进行呼吸机滴定研究前可获得呼吸机设备，并可逐步开始呼吸机治疗。根据平均使用天数和每晚平均使用时间的百分比，对 PAP 下载进行审查，以确定依从性的改善情况。结果38 名儿科患者完成了 PAP 治疗算法。按使用天数百分比计算的 PAP 依从性有了明显改善（配对 t 检验 P 值 = 0.04），平均每晚使用时间也有所改善（但无统计学意义）。患者从睡眠高级执业医师的密切随访中获益匪浅。与儿科行为心理学家会诊的患者在使用天数百分比和平均每晚使用天数方面均有显著改善。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.