Barriers to treatment of paediatric obstructive sleep apnoea: Development of the adherence barriers to continuous positive airway pressure (CPAP) questionnaire

Simon, Stacey L.; Duncan, Christina L.; Janicke, David M.; Wagner, Mary H.

doi:10.1016/j.sleep.2011.10.026

Cited by 63 publications

(53 citation statements)

References 22 publications

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“…Several retrospective and observational studies also implicate some of these factors in poor CPAP adherence in the pediatric population. However, although only a few prospective studies, 43,44 discussed herein, are available, these seem to demonstrate a different profile of factors from those shown to predict poor adherence in adults.…”

Section: Factors Influencing Cpap Adherencementioning

confidence: 77%

“…A significant portion of the literature on adherence has focused predominantly on the concerns of the patients’ family alone. 58 To address this gap, Simon and colleagues 44 constructed a psychometric questionnaire to evaluate child and family barriers to CPAP adherence. The Adherence Barriers to CPAP Questionnaire (ABCQ) included 31 questions developed across several conceptually derived domains including side effects, time management, health care provider relationships, equipment concerns, and family support, to name a few.…”

Section: Overcoming Barriers To Adherencementioning

confidence: 99%

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Improving Positive Airway Pressure Adherence in Children

King

Xanthopoulos

Marcus

2014

Sleep Medicine Clinics

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Section: Factors Influencing Cpap Adherencementioning

confidence: 77%

Section: Overcoming Barriers To Adherencementioning

confidence: 99%

Improving Positive Airway Pressure Adherence in Children

King

Xanthopoulos

Marcus

2014

Sleep Medicine Clinics

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“…Hawkins, MD 1,2 ; Emily L. Jensen, BS 3,4 may result in development of the aforementioned comorbidities, compromised daily functioning, increased health care utilization, and contribution to early mortality. 6,[15][16][17][18][19][20][21][22][23] OSA severity, pressure settings, and mask type, have not been found to affect use, 14,[24][25][26][27][28][29][30] whereas psychosocial factors and perception of OSA's importance do. 14,23,31 One study suggested that higher maternal education correlated with higher adherence.…”

Section: Correlates Of Pediatric Cpap Adherencementioning

confidence: 99%

Correlates of Pediatric CPAP Adherence

Hawkins

Jensen

Simon

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ 2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

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“…[9][10][11][12] CPAP adherence patterns of adolescents have not been extensively studied, but studies of medication adherence in other adolescent groups, such as asthmatics, epileptics, and diabetics have demonstrated poor adherence. 13,14 Poor adherence in adolescents may be related to not understanding or not perceiving the benefi ts of the treatment, wanting to conform to peers, and rebelling against authority.…”

mentioning

confidence: 99%

Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

Prashad

Marcus

Maggs

et al. 2013

Journal of Clinical Sleep Medicine

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adolescents and their caregivers. To our knowledge, this is the fi rst study focused on the adolescent age group.The purpose of the study was to identify and explore factors that infl uenced adolescent CPAP use, using a modifi ed grounded theory approach.16 Grounded theory is a qualitative method that seeks to generate theories from the data, to offer explanations for the phenomenon being explored. METHODSThis exploratory study consisted of qualitative semi-structured interviews and a download of the adolescent's adherence data from his or her CPAP machine during the previous month.Study Objectives: Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers.Methods: Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modifi ed grounded theory approach, we identifi ed themes and developed theories that explained the adolescents' adherence patterns. Results: Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefi ts were issues that played a role in CPAP adherence. Conclusions: Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our fi ndings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea syndrome (OSAS) affects approximately 2% of children and adolescents.1 OSAS in children may result in severe complications if left untreated, such as growth failure, pulmonary hypertension, neurocognitive defi cits, behavioral problems, and attention defi cit hyperactivity disorder. [2][3][4][5][6] In young children, OSAS can often be treated with adenotonsillectomy. However, in adolescents, adenotonsillectomy may not be effective, as adenoids and tonsils involute with age 7,8 and obesity is more likely to be present. While weight loss may be an effective treatment for OSAS in this age group, it is difficult to achieve and maintain, particularly for those with severe o...

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Barriers to treatment of paediatric obstructive sleep apnoea: Development of the adherence barriers to continuous positive airway pressure (CPAP) questionnaire

Cited by 63 publications

References 22 publications

Improving Positive Airway Pressure Adherence in Children

Improving Positive Airway Pressure Adherence in Children

Correlates of Pediatric CPAP Adherence

Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

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