Factors affecting pediatric adherence to positive airway pressure: Patient- and caregiver-reported treatment barriers and sleep difficulties

• Published in: Sleep medicine 2023-01, Vol.101, p.58-65
• Main Authors: Carmody, Julia K., Duraccio, Kara McRae, Krietsch, Kendra N., Simmons, Danielle M., Byars, Kelly C.
• Format: Article
• Language: English
• Subjects: Adherence; Adolescent; Adult; Automatic positive airway pressure treatment (AutoPAP); Bi-level positive airway pressure treatment (BiPAP); Caregivers; Child; Child, Preschool; Continuous positive airway pressure (CPAP); Continuous Positive Airway Pressure - methods; Humans; Patient Compliance; Patients; Pediatric; Sleep Apnea Syndromes - complications; Sleep disordered breathing (SDB); Sleep Initiation and Maintenance Disorders - complications; Young Adult
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2022.10.011

Adherence to positive airway pressure (PAP) treatment among children and adolescents is often suboptimal. Little is understood about modifiable determinants of PAP adherence. We evaluated whether patient and caregiver-perceived treatment barriers (across behavioral, environmental, emotional, and physical domains), as well as insomnia severity, were associated with PAP adherence among youth with sleep disordered breathing (SDB). We conducted a retrospective review of 188 patients prescribed PAP, ages 2–19 years. At the clinical visit, PAP adherence was assessed via objective download/smartcard and patients and their caregivers completed validated standardized questionnaires on barriers to PAP adherence and sleep onset and maintenance difficulties. We tested predictors of PAP adherence using linear regression. On average, patients wore their PAP 2/3 of nights for 5.3 ± 3.4 h. Patients reported more barriers overall compared to caregivers, and specifically more behavioral and emotional barriers (e.g., over a third of patients reported they just want to forget about sleep apnea). After controlling for demographic/treatment characteristics, patient-reported barriers accounted for a significant proportion of the variance in percent nights used (51%) and average nightly use (42%). Greater difficulties with sleep maintenance predicted poorer PAP adherence (percent nights and nightly duration). Study findings suggest that assessment of both patient and caregiver-perceived barriers to PAP adherence, as well as evaluating for sleep maintenance concerns, may provide important treatment targets for promoting PAP adherence among youth. Results also support the potential benefit of a multi-disciplinary team-based approach to managing SDB and promoting PAP adherence. •Little is understood about modifiable determinants of positive airways pressure (PAP) adherence in youth.•Patients reported more barriers to using PAP compared to their caregivers, including more behavioral and emotional barriers.•Greater difficulties with sleep maintenance predicted poorer PAP adherence.•Understanding patient and caregiver-perceived barriers, and sleep concerns, may provide key adherence promotion targets.