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Sleep Apnea, ObstructiveIPADNCT07176767

The IPAD Cohort Study: Insomnia and Positive Airway Pressure Adherence in Children and Adolescents

An observational study of Sleep Apnea, Obstructive and Insomnia, run by Lena Xiao at 1 site in Canada.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Positive Airway Pressure (PAP) is a treatment used to help people with sleep-disordered breathing, particularly those with obstructive sleep apnea (OSA). The device delivers pressurized air through a mask to keep the airways open during sleep, improving breathing and preventing interruptions in sleep. Read more about this study

Who is it for?
Ages 8 to 18 years
Conditions the study is for
Sleep Apnea, Obstructive, Insomnia
What is being tested?
Positive airway pressure therapy
Type of treatment
Medical device
How many people
82 participants
Where
1 siteCanada
Study dates
12 Jun 2025to 31 Dec 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 8 to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Study population: Participants will be recruited from two tertiary care academic hospitals, The Hospital for Sick Children (Toronto, Canada) and British Columbia Children's Hospital (BCCH) (Vancouver, Canada).

Who may be able to join

  • Children aged 8-18 years old
  • Obstructive apnea-hypopnea index ≥ 5/hour on baseline diagnostic polysomnogram (PSG)
  • Newly prescribed PAP therapy

Who cannot join

  • 1) Developmental disability precluding ability to answer questionnaires

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Lena J Xiao, MD MSc contact

6048752345 ext. 7606

lena.xiao@cw.bc.ca

Macyn LY Leung, MSc contact

6048752345 ext. 7606

macyn.leung@bcchr.ca

Canada1 site, 1 recruiting
  • British Columbia Children's Hospital

    Vancouver, British Columbia, V6H 3N1

    Lena J Xiao, MD MSc, 6048752345 ext. 7606, lena.xiao@cw.bc.ca

    Macyn LY Leung, MSc, 6048752345 ext. 7606, macyn.leung@bcchr.ca

    Recruiting

Other trials in Canada

About this study

Positive Airway Pressure (PAP) is a treatment used to help people with sleep-disordered breathing, particularly those with obstructive sleep apnea (OSA). The device delivers pressurized air through a mask to keep the airways open during sleep, improving breathing and preventing interruptions in sleep.

Studying how insomnia affects PAP adherence in children can help improve future treatments.

However, no long-term studies have looked at this in children. Based on previous research, the investigators plan to conduct a study across multiple centers focusing on children with OSA starting PAP therapy. The study will explore how insomnia affects PAP adherence and how race and ethnicity play a role.

Read the detailed description

The first line of treatment for obstructive sleep apnea (OSA) is positive airway pressure (PAP) therapy, yet children have a less than 50% adherence rate, leaving many undertreated for this condition. Insomnia has been established as a modifiable risk factor for lowering PAP therapy adherence in adults with comorbid insomnia and sleep apnea (COMISA), and research has shown that treating insomnia with cognitive behavioural therapy for insomnia (CBTi) improved PAP adherence in adults. This is an important step forward for improving COMISA treatment outcomes, but cannot yet be applied to children without researching this relationship in paediatric populations. This study will address this research gap by conducting a thorough, in-depth evaluation of the association between paediatric COMISA and PAP adherence. The investigators aim to find whether a causal relationship exists between insomnia and PAP adherence in children with OSA, which has never been assessed longitudinally in children.

This multicenter study will be conducted at two tertiary care academic hospitals: The Hospital for Sick Children (Toronto, Canada) and British Columbia Children's Hospital (BCCH) (Vancouver, Canada). This study will include 82 participants from a diverse population to assess the association between race and ethnicity with PAP therapy adherence, based on previous research showing that being part of a self-identified minority is associated with lower PAP therapy adherence. Participants and caregivers will be asked to complete questionnaires regarding insomnia, sleep behaviour and quality of life at baseline prior to PAP therapy initiation. Electronic follow up questionnaires will be administered at 1, 2, and 3 months after PAP therapy initiation and PAP download data will be completed remotely. The primary objective of this study is to evaluate the impact of baseline insomnia on PAP therapy adherence at 3 months based on self-identified racial and ethnic minority. The results of this study will provide treatment insight and improvement to children with COMISA being treated with PAP therapy.

Being tested
Positive airway pressure therapy
Keywords
Obstructive Sleep Apnea, Insomnia, Pediatric Sleep, Positive Airway Pressure Adherence
Medical subject headings
Sleep Apnea, Obstructive, Sleep Initiation and Maintenance Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Positive airway pressure therapyDevice

    Also called Continuous positive airway pressure therapy, Bilevel positive airway pressure therapy

    Initiation of continuous or bilevel positive airway pressure therapy

Study groups in NCT07176767
Study groupRoleWhat they receive
OSA Children Starting PAPChildren aged 8-18 years old diagnosed with obstructive sleep apnea (OSA) who are to be initiated on Positive Airway Pressure (PAP) therapy. Children and their caregivers must be willing and able to complete questionnaires about sleep as well as physical and mental health.
Receives: Device: Positive airway pressure therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean minutes of nightly PAP usage

    Adherence will be determined objectively using ventilator download data (days 60-90 after PAP initiation)

    Measured: 90 days

Secondary outcomes (28)
  1. Mean minutes of nightly PAP usage

    Adherence will be determined objectively using ventilator download data (days 0-30 and 30-60 after PAP initiation)

    Measured: 30, 60 days

  2. Self-Reported Sense of Mastery (Caregiver)

    The self-reported Pearlin Mastery Scale will be used to measure the caregiver's mastery. Scores range from 7 to 28, with higher scores indicating greater levels of mastery.

    Measured: 0, 90 days

  3. Self-Reported Sense of Mastery (Participant)

    The self-reported Pearlin Mastery Scale will be used to measure the participant's individual mastery. Scores range from 7 to 28, with higher scores indicating greater levels of mastery.

    Measured: 0, 90 days

  4. Self-Reported Psychological Scale (Percentage Rank)

    The self-reported Psychological Scale from the KIDSCREEN-10 questionnaire will be used to measure health-related quality of life. The score ranges from 10-50, with lower scores indicating a "dissatisfaction with life".

    Measured: 0, 90 days

  5. Self-Reported Psychological Scale

    The self-reported Psychological Scale from the Strengths and Difficulties questionnaire will be used. Scores range from 0-50 with higher scores indicating more difficulties and lower scores indicating more strengths.

    Measured: 0, 90 days

  6. Self-Reported Sleep Diary

    The self-reported National Institutes of Health (NIH) 1-week Sleep Diary will be used to record the quality and quantity of sleep.

    Measured: 0, 90 days

  7. Caregiver-Reported Insomnia Questionnaire

    The caregiver-reported Pediatric Insomnia Severity Index will be used to measure the severity of pediatric insomnia symptoms. Scores range from 0 to 30, with higher scores indicating greater insomnia severity.

    Measured: 0, 90 days

  8. Self-Reported Insomnia Questionnaire (Participant)

    The self-reported Insomnia Severity Index will be used to measure the nature, severity and impact of the participant's insomnia. Scores range from 0 to 28, with higher scores indicating greater insomnia severity.

    Measured: 0, 30, 60, 90 days

  9. Self-Reported Insomnia Questionnaire (Participant)

    The self-reported Insomnia Severity Index will be used to diagnose insomnia in the participant. Children will be classified as having insomnia using a cut-off of ≥ 9 points, based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition.

    Measured: 0, 30, 60, 90 days

  10. Self-Reported Insomnia Questionnaire (Caregiver)

    The self-reported Insomnia Severity Index will be used to measure the nature, severity and impact of the caregiver's insomnia. Scores range from 0 to 28, with higher scores indicating greater insomnia severity.

    Measured: 0, 90 days

  11. Self-Reported Insomnia Questionnaire (Caregiver)

    The self-reported Insomnia Severity Index will be used to diagnose insomnia in the caregiver. Caregiver's will be classified as having insomnia using a cut-off of ≥ 9 points, based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition.

    Measured: 0, 90 days

  12. Self-Reported Chronotype Questionnaire

    The self-reported Munich Chronotype Questionnaire will be used to measure participant chronotype. Scores range from 16 to 86 with scores below 42 indicating "evening types", scores between 42-58 indicating "intermediate types" and scores above 58 indicating "morning types".

    Measured: 0, 90 days

  13. Self-Reported Chronotype Questionnaire

    The self-reported Morningness/Eveningness Questionnaire will be used to measure differences in activeness and alertness in the mornings and evenings. Scores range from 16 to 86, with lower scores representing evening preference and higher scores representing morning preference.

    Measured: 0, 90 days

  14. Caregiver's Self-Reported Chronotype Questionnaire

    The self-reported Morningness/Eveningness Questionnaire will be used to measure the caregiver's differences in activeness and alertness in the mornings and evenings. Scores range from 16 to 86, with lower scores representing evening preference and higher scores representing morning preference.

    Measured: 0, 90 days

  15. Self-Reported Daytime Sleepiness Questionnaire

    The self-reported Epworth Sleepiness Scale will be used to measure daytime sleepiness. Scores range from 0-24 with lower score indicating less daytime sleepiness.

    Measured: 0, 90 days

  16. Self-Reported Caffeine Intake Questionnaire

    The self-reported Caffeine Consumption Questionnaire-Revised will be used to measure weekly caffeine intake. The quantity and frequency of caffeinated products reported is used to estimate the average daily caffeine consumption in mg.

    Measured: 0, 90 days

  17. Self-Reported Sleep Hygiene Questionnaire

    The self-reported Adolescent Sleep Hygiene Scale (ASHS) will be used to assess sleep habits and hygiene practices. The 33-item scale contains 28 quantitative items, which are scored as the following: never (0%) = 1; once in a while (20%) = 2; sometimes (40%) = 3; quite often (60%) = 4; frequently, if not always (80%) = 5; always (100%) = 6. Total scores range from 28-168, with higher scores indicating greater sleep hygiene.

    Measured: 0, 90 days

  18. Caregiver-Reported Global Rating Scale of Change

    The caregiver-reported Global Rating Scale of Change will be used to measure the caregiver's perceived improvement or deterioration of the child's quality of life over time. The scale ranges from -7 to +7, with greater scores indicating improvements in quality of life.

    Measured: 90 days

  19. Self-Reported Global Rating Scale of Change

    The self-reported Global Rating Scale of Change will be used to measure the participant's perceived improvement or deterioration of their quality of life over time. The scale ranges from -7 to +7, with greater scores indicating improvements in quality of life.

    Measured: 90 days

  20. Self-Reported PAP Adherence Questionnaire

    The self-reported Adherence Barriers to CPAP Questionnaire will be used to estimate the participant's success or failure to use their PAP. The score ranges from 31 to 155, with greater scores indicating a higher number and severity of CPAP barriers.

    Measured: 90 days

  21. Self-Reported Psychological (Total Anxiety) Subscale

    The self-reported Total Anxiety Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-45, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  22. Self-Reported Psychological (Total Depression) Scale

    The self-reported Total Depression (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-30, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  23. Self-Reported Psychological (Social Phobia) Scale

    The self-reported Social Phobia Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-27, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  24. Self-Reported Psychological (Panic Disorder) Scale

    The self-reported Panic Disorder Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-27, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  25. Self-Reported Psychological (Major Depression) Scale

    The self-reported Major Depression Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-30, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  26. Self-Reported Psychological (Separation Anxiety) Scale

    The self-reported Separation Anxiety Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-21, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  27. Self-Reported Psychological (Generalized Anxiety) Scale

    The self-reported Generalized Anxiety Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-18, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

  28. Self-Reported Psychological (Obsessive-Compulsive) Scale

    The self-reported Obsessive-Compulsive Subscale (major outcome) from the Revised Child Anxiety and Depression Scale will be used. The raw score from the subscale, which ranges from 0-18, will be used to calculate the T score by taking into consideration development level and gender. A T score of 65 or higher indicates a score borderline the clinical threshold and a T score of 70 or higher indicates a score above the clinical threshold.

    Measured: 0, 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Sep 2025
  2. Study start12 Jun 2025
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
82 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07176767
Sponsor's protocol ID
H25-00289
Other IDs
354-FP-24
Acronym
IPAD
Status last verified
Sep 2025
First submitted
9 Sep 2025
Last updated
23 Sep 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

An observational study of Sleep Apnea, Obstructive and Insomnia, run by Lena Xiao at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 23 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Lena J Xiao, MD MSc (6048752345 ext. 7606, lena.xiao@cw.bc.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean minutes of nightly PAP usage (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Sep 2025.

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