An Overview and Application of Evidence-Based Interventions to Improve Adherence to Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea

• Published in: Clinical practice in pediatric psychology 2022-12, Vol.10 (4), p.384-393
• Main Authors: Levert, Dominique, Maniaci, Jon, Tapia, Ignacio E., Xanthopoulos, Melissa S.
• Format: Article
• Language: English
• Subjects: Evidence Based Practice; Human; Intervention; Pediatrics; Self-Management; Sleep Apnea; Syndromes; Treatment; Treatment Compliance
• ISSN: 2169-4826; 2169-4834
• DOI: 10.1037/cpp0000465

Objective: The purpose of this manuscript is to provide an overview of evidence-based strategies designed to promote adherence to and self-management of positive airway pressure (PAP) for the treatment of pediatric obstructive sleep apnea syndrome (OSAS) with an emphasis on those who are disproportionately impacted by OSAS. Methods: Utilized four recently published review articles and a book chapter, as well as a search of the literature since the most recent scoping review was published, to identify factors impacting pediatric adherence to PAP. Proposed conceptual models for self-management and adherence were also evaluated and strategies addressing factors within the context of these models were reviewed for application. Results: Evidence-based cognitive-behavioral strategies within a bio-socioecological framework and interdisciplinary team-based model are presented. A case study highlights the application of these interventions using an interdisciplinary coordinated care model, including clinical outcome data (e.g., objective adherence measures from the PAP device). Conclusions: Existing evidence supports a family-centered interdisciplinary approach to initiating PAP and supporting long-term PAP adherence for the treatment of pediatric OSAS. A bio-socioecological framework provides structure for assessment and flexibility in which interventions, such as education, cognitive-behavioral strategies, and social support, can be tailored to the unique needs of each child and family. Implications for Impact Statement Starting and regularly using positive airway pressure (PAP) for the treatment of obstructive sleep apnea syndrome (OSAS) in children is challenging due to an interplay of medical, developmental, behavioral, social, interpersonal, and technical factors. Assessment of these factors and identification of specific challenges for an individual child and their family can provide a framework in which evidence-based strategies can be applied to improve the initiation and long-term use of PAP. Education, cognitive-behavioral strategies, and social support provided by an interdisciplinary team can be tailored to the unique needs of each child and family to facilitate acceptance and long-term use of this efficacious treatment.