Evaluation of a New Threshold for Positive Airway Pressure Therapy Adherence in Paediatric Populations
Bibliographic record
Abstract
Abstract RATIONALE: Obstructive sleep apnea (OSA) in children is a common disorder of breathing during sleep that is characterized by upper airway obstruction and is treated using positive airway pressure (PAP) therapy. There is no standardized definition for PAP adherence for paediatric populations. Instead, current adherence criteria is based on the adult definition, defined as >4 hours of PAP use for at least 70% of nights. This relatively low threshold likely under-estimates PAP adherence in children, as children require more sleep than adults do. Thus, we propose defining paediatric PAP adherence as PAP usage for at least 6 hours per night for 100% of nights. The objective of this study is to evaluate PAP adherence in children with OSA using an adherence threshold of a minimum of 6 hours of PAP use per night for 100% of nights. METHODS: The study prospectively recruited children aged 4-18 years old who were prescribed PAP therapy at SickKids. Detailed PAP adherence data was obtained directly from PAP machines. PAP therapy utilization and adherence was analyzed using descriptive statistics. RESULTS: A total of 150 children were included, (median age = 14.0 years, females = 38.7%). Using a criteria of >4 hours of PAP use for at least 70% of nights, 74/150 (49.3%) of children were considered adherent. When applying our proposed >6 hours of PAP use for 100% of nights, only 33/150 (22.0%) met the criteria for PAP adherence. CONCLUSION: Our data reveals that a significant portion of children do not meet the threshold of 6 hours of PAP use for 100% of nights, emphasizing the need for a revised definition that reflects the unique sleep requirements of children. This data also highlights an urgent need for alternative, efficacious therapies for OSA as a significant number of children are not adherent to PAP therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".