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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05949164
Other study ID # 1000080572
Secondary ID
Status Recruiting
Phase
First received
Last updated
Start date May 16, 2023
Est. completion date May 1, 2024

Study information

Verified date July 2023
Source The Hospital for Sick Children
Contact Lena Xiao, MD
Phone 416-813-6346
Email lena.xiao@sickkids.ca
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Sleep-disordered breathing (SDB) is prevalent in children and adolescents and untreated SDB impacts key indicators of physical and psychosocial health. Positive airway pressure (PAP) therapy is highly effective for the treatment of SDB and is associated with favorable clinical outcomes but is limited by poor adherence. Emerging literature in adults suggests that intolerance to PAP therapy may be related to coexisting insomnia. However, the presence of insomnia in children with known SDB as well as its impact on PAP adherence have not been explored. This proposal will explore the association of coexisting insomnia on PAP adherence in children with SDB using a cross-sectional study design. The investigators will assess the association between insomnia and PAP therapy adherence, measured as the mean minutes of nightly PAP usage over 6 months of use on objective downloads.


Description:

Sleep-disordered breathing (SDB) is prevalent in children and adolescents and untreated SDB impacts key indicators of physical and psychosocial health. Positive airway pressure (PAP) therapy is highly effective for the treatment of SDB and is associated with favorable clinical outcomes but is limited by poor adherence. Emerging literature in adults suggests that intolerance to PAP therapy may be related to coexisting insomnia. This study addresses a critical knowledge gap regarding the association between insomnia and PAP therapy adherence amongst children with SDB. These results will inform future prospective studies on targeted effective interventions to improve PAP adherence in children with SDB. SDB encompasses a range of breathing disorders during sleep including obstructive sleep apnea (OSA), central sleep apnea (CSA), and hypoventilation. PAP therapy is a common treatment modality for SDB that is often implemented after targeted treatment strategies do not fully cure SDB. PAP therapy, which delivers pressurised air via nasal or oronasal interfaces, effectively distends the upper airway to ameliorate OSA and can assist ventilation with pressure support breaths. PAP is highly efficacious when used on a nightly basis and is typically required for many years into adulthood. The use of PAP has been associated with increased survival and improved health-related quality of life in people with neuromuscular disease. However, SDB remains undertreated or untreated in many children due to poor adherence. A deeper understanding of associations with PAP adherence across the diagnostic spectrum may yield greater benefits for all children on PAP therapy. Insomnia is highly prevalent in childhood, occurring in up to 37% of children. Insomnia is associated with reduced cognition and academic functioning as well as reduced health-related quality of life, substance use, and increased risk of psychiatric problems. There is emerging evidence that insomnia commonly coexists with OSA in children. A bi-directional causal relationship likely exists whereby OSA is exacerbated by sleep fragmentation, hyper-arousal, and modified sleep architecture associated with insomnia whereas insomnia symptoms are induced by repeated post-obstruction awakenings in OSA. Of importance is that coexisting insomnia and OSA is associated with greater morbidity than either condition alone. To date, there is minimal reported literature on coexisting insomnia with other SDB including CSA and nocturnal hypoventilation. Although similar pathophysiological mechanisms may exist for CSA, there has been little reported in the literature regarding these relationships. More recently, insomnia has been identified as a risk factor for reduced PAP therapy adherence rates in adult populations due to hypersensitivity to PAP equipment side effects, early discontinuation of therapy, and reduced sleep duration. The impact of insomnia on PAP adherence has never been explored in children. Further, the impact of insomnia on PAP adherence in populations with other SDB diagnoses other than OSA has yet to be explored. Elucidating the impact of coexisting insomnia on PAP adherence may inform future targeted management strategies to improve PAP adherence, such as the addition of cognitive behavioral therapy, and may lead to improved outcomes in children with SDB.


Recruitment information / eligibility

Status Recruiting
Enrollment 260
Est. completion date May 1, 2024
Est. primary completion date May 1, 2024
Accepts healthy volunteers No
Gender All
Age group 4 Years to 17 Years
Eligibility Participant Inclusion Criteria In order to be eligible to participate in this study, an individual must meet all of the following criteria: 1. Children aged 4-17 years old 2. Prescribed PAP therapy for at least 6 months Participant Exclusion Criteria An individual or caregiver who meets one or more of the following criteria will be excluded from participation in this study: 1) Limited knowledge and proficiency in English to complete the study as judged by the clinical team.

Study Design


Intervention

Behavioral:
Insomnia
The primary exposure is insomnia

Locations

Country Name City State
Canada The Hospital for Sick Children Toronto Ontario

Sponsors (1)

Lead Sponsor Collaborator
The Hospital for Sick Children

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary PAP therapy adherence PAP therapy adherence measured as the mean minutes of nightly PAP usage over 6 months 6 months
Secondary PAP therapy adherence PAP therapy adherence expressed as a percentage of total sleep time 6 months
Secondary PAP therapy adherence PAP therapy adherence measured as the mean minutes of nightly PAP usage over 3 months 3 months
Secondary PAP therapy adherence PAP therapy adherence expressed as a percentage of total sleep time 3 months
Secondary PAP therapy adherence PAP therapy adherence measured as the mean minutes of nightly PAP usage over 2 weeks 2 weeks
Secondary PAP therapy adherence PAP therapy adherence expressed as a percentage of total sleep time 2 weeks
Secondary PAP therapy adherence PAP therapy adherence expressed as a dichotomous outcome (PAP usage for at least 4 hours per night for 70% of nights) 3 months
Secondary PAP therapy adherence PAP therapy adherence expressed as a dichotomous outcome (PAP usage for at least 6 hours per night for 70% of nights) 3 months
Secondary PAP therapy adherence PAP therapy adherence expressed as a dichotomous outcome (PAP usage for at least 4 hours per night for 70% of nights) 6 months
Secondary PAP therapy adherence PAP therapy adherence expressed as a dichotomous outcome (PAP usage for at least 6 hours per night for 70% of nights) 6 months
Secondary Physical Well-being (percentage rank) The Physical Well-being Scale from the KIDSCREEN-27 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating lower physical well-being. 1 week
Secondary Psychological Well-being (percentage rank) The Psychological Well-being Scale from the KIDSCREEN-27 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating a "dissatisfaction with life". 1 week
Secondary Autonomy and Parent Relation (percentage rank) The Autonomy and Parent Relation Well-being Scale from the KIDSCREEN-27 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating lower autonomy. 1 week
Secondary Self-Perception (percentage rank) The Self-Perception Scale from the KIDSCREEN-27 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating lower self-perception. 1 week
Secondary Social Support and Peers (percentage rank) The Social Support and Peers Scale from the KIDSCREEN-27 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating lower social support. 1 week
Secondary Daytime Sleepiness The Epworth Sleepiness Scale is scored from 0-24, with higher scores indicating greater sleepiness. 1 month
Secondary Depressive Symptoms (T-score) The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Item Bank v2.0 - Depressive Symptoms Questionnaire generates a T-score. Higher scores indicate increased depressive symptoms (patient-reported questionnaire range 35.2-82.4). 7 days
Secondary Depressive Symptoms (T-score) The Patient-Reported Outcomes Measurement Information System (PROMIS) Parent Proxy Bank v2.0 - Depressive Symptoms Questionnaire generates a T-score. Higher scores indicate increased depressive symptoms (proxy-reported questionnaire range 36.2-84.7). 7 days
Secondary Anxiety Symptoms (T-score) The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Bank v2.0 - Anxiety Questionnaire generates a T-score. Higher scores indicate increased anxiety symptoms (patient-reported questionnaire range 33.5-83.3). 7 days
Secondary Anxiety Symptoms (T-score) The Patient-Reported Outcomes Measurement Information System (PROMIS) Parent Proxy Bank v2.0 - Anxiety Questionnaire generates a T-score. Higher scores indicate increased anxiety symptoms (proxy-reported questionnaire range 34.6-86.4). 7 days
Secondary Chronotype Measured with the Children's Chronotype Questionnaire. The chronotype categorizations including morningness, eveningness, and neither. 4 week
Secondary Chronotype Measured with the Reduced Morningness-Eveningness questionnaire. The chronotype categorizations including morningness, eveningness, and neither. 4 week
Secondary Chronotype Measured with the Munich Chronotype Questionnaire for Children and Adolescents. The chronotype categorizations including morningness, eveningness, and neither. 4 week
Secondary Mid-Sleep Point Measured with the Munich Chronotype Questionnaire for Children and Adolescents 4 week
Secondary Mid-Sleep Point Measured with the Children's Chronotype Questionnaire 4 week
Secondary Sleep Hygiene (total score) The Adolescent Sleep Hygiene Scale total score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Physiological Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Behavioral Arousal Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Cognitive/Emotional Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Sleep Environment Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Sleep Stability Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Daytime Sleep Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Substances Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Sleep Hygiene (Bedtime Routine Factor) Subscale from the Adolescent Sleep Hygiene Scale total score. The score ranges from 1-6. Higher scores indicate better success with sleep hygiene. 1 month
Secondary Adherence Barriers to CPAP The score range for the Adherence Barriers to CPAP Questionnaire is 31-155. Higher scores indicate more barriers. 2 weeks
Secondary Total Difficulties Score The Strengths and Difficulties Questionnaire generates a total difficulties score ranging from 0-40, with higher scores indicating greater behavioral difficulty. 6 months
Secondary Emotional Problems Score The Strengths and Difficulties Questionnaire generates an emotional problems score ranging from 0-10, with higher scores indicating greater difficulty. 6 months
Secondary Conduct Problems Score The Strengths and Difficulties Questionnaire generates a conduct problems score ranging from 0-10, with higher scores indicating greater difficulty. 6 months
Secondary Hyperactivity Score The Strengths and Difficulties Questionnaire generates a hyperactivity score ranging from 0-10, with higher scores indicating greater difficulty. 6 months
Secondary Peer Problems Score The Strengths and Difficulties Questionnaire generates a peer problems score ranging from 0-10, with higher scores indicating greater difficulty. 6 months
Secondary Prosocial Score The Strengths and Difficulties Questionnaire generates a prosocial score ranging from 0-10, with higher scores indicating greater prosocial behavior. 6 months
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