Factors affecting pediatric adherence to positive airway pressure

What is it about?

This study included a retrospective medical chart review of pediatric patients prescribed positive airway pressure (PAP) to identify predictors of PAP adherence. PAP adherence was assessed as part of patients’ clinic visits via: 1) objective download/smartcard; and 2) patient- and parent-report surveys. On average, pediatric patients in the current study used their prescribed PAP 68% of nights for an average of 5.25 hours per night. Patients reported more PAP adherence barriers (i.e., behavior, beliefs, & environment and emotional) than caregivers. Patient-reported PAP adherence barriers accounted for a significant percentage of the variance in PAP adherence (i.e., 51% for percent nights used and 42% for average nightly use). Further, difficulties with sleep maintenance predicted PAP adherence, such that those with greater reported difficulty with sleep maintenance reported lower PAP adherence.

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Photo by Slaapwijsheid.nl on Unsplash

Photo by Slaapwijsheid.nl on Unsplash

Why is it important?

Findings suggest that: 1) pediatric PAP adherence is suboptimal; 2) patients and caregivers have differing reports of pediatric PAP adherence barriers; and 3) difficulties with sleep maintenance may predict pediatric PAP adherence. It will be important for sleep medicine clinics to routinely assess pediatric PAP adherence, as well as PAP adherence barriers (from the perspective of both patients and caregivers), to fully understand and address a patient’s PAP adherence barriers and promote pediatric PAP adherence. Additionally, results suggest that routine assessment of difficulties with sleep maintenance will be important as it may serve as an intervention target to promote pediatric PAP adherence. Ultimately, the authors argue for the importance of a multidisciplinary team-based approach to sleep medicine and promotion of pediatric PAP adherence.