Adult-derived definitions overestimate adherence to pediatric long-term non-invasive ventilation, and a novel age-based physiological definition using ≥70% of minimum age-specific recommended sleep duration on ≥70% of nights yields significantly lower adherence rates than commonly used adult thresholds.
Key Findings
Results
The novel age-based physiological definition yielded a significantly lower adherence rate than both adult-derived definitions.
Adherence rate was 66.25% under the novel definition (≥70% of minimum age-specific recommended sleep duration on ≥70% of nights).
Adherence rate was 83.75% under the classic adult-derived definition (≥4 h/night on ≥50% of nights), p=0.0005 compared to novel definition.
Adherence rate was 78.75% under the current adult-derived definition (≥4 h/night on ≥70% of nights), p=0.0039 compared to novel definition.
Results highlight 'an overestimation of adherence when adult definitions are used.'
Methods
The study included 80 pediatric patients on long-term non-invasive ventilation with a median age of 9.01 years.
Median age was 9.01 years (IQR 5.96–14.09).
Age range was 0.15–18 years.
The most frequent diagnoses were neuromuscular disorders (31%) and genetic disorders (15%).
This was a retrospective cross-sectional study conducted at Hospital Garrahan, Argentina.
Results
The vast majority of patients were initiated on LT-NIV electively and had objective evidence of sleep-disordered breathing.
LT-NIV was initiated electively in 91% of patients.
75% of patients reported sleep-disordered breathing symptoms.
Polysomnography was abnormal in 95.2% of patients.
Results
Poorer adherence was associated with several patient and clinical characteristics.
Younger age was associated with poorer adherence.
Developmental delay was associated with poorer adherence.
Absence of symptoms was associated with poorer adherence.
Earlier ventilation initiation and lower pressure settings were also associated with poorer adherence.
Methods
The novel definition replaces a fixed nightly hour threshold with one tailored to each child's age-specific sleep needs based on AASM consensus recommendations.
The proposed definition classifies patients as 'adherent' when LT-NIV use reaches ≥70% of the minimum age-specific recommended sleep duration according to the American Academy of Sleep Medicine (AASM) consensus.
Adherence requires this threshold to be met on ≥70% of nights.
This approach contrasts with the fixed 4 h/night threshold used in both adult-derived definitions, which does not account for varying sleep needs across pediatric age groups.
The authors describe this as the 'first study' to explore a novel pediatric adherence definition for LT-NIV.
What This Means
This research suggests that the way doctors currently measure whether children are properly using their breathing support machines at night (called non-invasive ventilation, or NIV) may be misleading. The standard used for adults — requiring at least 4 hours of device use per night — has been borrowed for use in children, even though children of different ages need very different amounts of sleep. For example, a toddler needs far more sleep than a teenager, so 4 hours out of a toddler's much longer night represents a much smaller fraction of their sleep than it does for an adult or older child.
This study of 80 children in Argentina tested a new definition of 'good adherence' that is adjusted for each child's age-appropriate sleep needs, requiring device use for at least 70% of the minimum recommended sleep time on at least 70% of nights. When this age-tailored definition was applied, only about 66% of children were classified as adherent, compared to 79–84% when the adult-derived definitions were used. This means the adult-based definitions were overestimating how well children were actually using their devices. The study also found that younger children, those with developmental delays, those without obvious symptoms, and those started on ventilation earlier tended to have worse adherence.
This research suggests that international guidelines for measuring pediatric NIV adherence need to be reconsidered, because using adult standards may give a falsely reassuring picture of how well children are complying with their treatment. Better-defined and age-appropriate standards could help clinicians identify children who are not getting enough ventilation support and intervene more effectively.
Check Your Own Numbers
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
Leske V, Dicembrino M. (2026). A novel age-based physiological definition of adherence to pediatric long-term non-invasive ventilation: an exploratory study.. Sleep & breathing = Schlaf & Atmung. https://doi.org/10.1007/s11325-026-03843-4