0760 One-Size-Does-Not-Fit-All: Achieving Positive Airway Pressure (PAP) Adherence in a Targeted Pediatric Population Beyond the 90-day Insurance Trial Period

Abstract

Introduction: Adherence to PAP therapy is a significant challenge in children, particularly those with developmental delay and multiple medical problems. Many insurance companies have adopted Medicare's criteria for PAP coverage, even in pediatric patients. Children on PAP therapy, particularly those with special medical needs, often require >; 90 days to achieve the definition of PAP adherence (≥ 4 hours of use, >;70% of nights, for 30 consecutive days). Methods: A retrospective chart review was performed on 6 children on PAP therapy at Children's Hospital of Wisconsin. Data was collected to describe the efforts and process to attain adherence criteria in these children. Results: We reviewed the charts of 5 males and 1 female with average age of 7.7 years. Reasons for PAP were obstructive sleep apnea and hypoventilation. Comorbidities included obesity, seizures, brainstem glioma, anxiety, ependymoma, myotubular myopathy, congenital myopathy status post heart transplant, Chiari malformation, Albright hereditary osteodystrophy, and Trisomy 21. The time to adherence was 6-66 months, with an average of 32.3 months. In order to maintain insurance coverage for PAP, 2 required a letter of medical necessity and 2 required phone calls to their durable medical equipment company. Overall, adherence was achieved in these children after an average of 6 clinic visits, 6 follow-up phone calls, 4 mask fittings in the sleep lab, and 3 PAP titration studies. Conclusion: In order to tolerate PAP, medically complex children may require multiple pressure adjustments, mask changes and/or clinic assessments, a process which can take several years to complete. Hence, allowing extended periods of time for acclimatization to PAP therapy in pediatric patients is essential to achieving and maintaining PAP adherence.