Positive airway pressure for the treatment of the childhood obstructive sleep apnea syndrome

Abstract

In this review, we have summarized the benefits of treatment with positive airway pressure for the childhood obstructive sleep apnea syndrome and presented a socio‐ecological framework to enhance our understanding of positive airway pressure adherence predictors and important targets of comprehensive positive airway pressure treatment models across different pediatric populations. Although positive airway pressure is clearly a beneficial treatment for pediatric obstructive sleep apnea syndrome, additional research is needed to evaluate how socio‐ecological factors may interact to predict positive airway pressure adherence, with more attention to the impact of the broader healthcare setting and on treatment approaches and outcomes in special pediatric populations.

A social media intervention for the families of young Black men with obstructive sleep apnoea

“…This study utilised available evidence regarding adolescents' perspectives of PAP (Alebraheem et al, 2018;Prashad et al, 2013) to develop and pilot-test an intervention intended to address these specific barriers and thereby improve adherence. These findings, with supplemental support of constructs embedded within social learning theory (Bandura, 1977) and the adapted socioecological framework for OSA (Bronfenbrenner, 1977;Xanthopoulos et al, 2021), provided the foundation and framework for the design of an online, peer-based, educational intervention for families. The intervention was designed to (1) provide OSA and PAP education to reinforce information provided in clinical visits, (2) provide a peer-based social network for communication and support for both parents and adolescents, (3) enable frequent contact between a provider and patients to rapidly address PAP issues and concerns and (4) improve or maintain motivation to use PAP.…”

“…As previously noted, preconceived notions about disease or treatment can impact adherence (Kirk and O'Donnell, 2006;Prashad et al, 2013;Taddeo et al, 2008;Xanthopoulos et al, 2017). Identifying preexisting attitudes and outcome expectations and dispelling disbeliefs is critical in the early stages of intervention (Kirk and O'Donnell, 2006;Xanthopoulos et al, 2021). Education that is provided in one clinic visit at OSA diagnosis and PAP initiation may be overwhelming, as individuals may only retain only two or three key messages per sitting, leading to inaccurate or incomplete comprehension of information about the diagnosis and treatment (Hardavella et al, 2017;Weiss, 2014).…”

“…Data indicated that 38.2% of children and adolescents terminated PAP use within the first 90 days of treatment and only 46.3% met adherence criteria, defined as ⩾4 hours per night on 70% of nights for 30 consecutive days within the first 90 days of treatment (Bhattacharjee et al, 2020; Centers for Medicare and Medicaid Services, 2016). Factors predicting adolescent PAP adherence have been limited and inconsistent (Watach et al, 2020), and the multi-layered and dynamic nature of socioecological factors that influence adherence further complicate utilisation (Xanthopoulos et al, 2021). Educational, behavioural and supportive interventions have proven beneficial for improving PAP adherence in adults (Askland et al, 2020), but few studies have evaluated the efficacy of specific interventions in children and adolescents (Bhattacharjee, 2021; Watach et al, 2020).…”

Noninvasive ventilation in children: A review for the pediatric anesthesiologist

“…Home NIV has been prescribed for various chronic diseases affecting respiratory function in children, especially in patients with decreased respiratory muscle strength and decrease respiratory drive due to neuronal disease 9 . A common indication for home CPAP in children is obstructive sleep apnea refractory to adenotonsillectomy, 18 where CPAP functions as a "splint" to maintain patency of the pharynx and upper airway, to improve airway obstruction, decrease respiratory muscle load, and reduce the work of breathing. Home NIV may also be prescribed for patients with chronic hypercapnic respiratory failure, specifically in patients with neuromuscular and chest wall disease such as children with Duchenne's muscular dystrophy 19 …”

Continuous positive airway pressure care for pediatric obstructive sleep apnea: A long‐term quality improvement initiative

“…[7][8][9] Continuous positive airway pressure (CPAP), a standard effective treatment for pediatric OSAS, 1 can be limited by adherence challenges. 10,11 Research indicates gradual increases in youth CPAP use over time, 12 making timely follow-up care critical in monitoring acceptance, adherence, effectiveness, side effects, and equipment. The American Academy of Sleep Medicine (AASM) and the American Academy of Pediatrics (AAP) recommend a titration polysomnogram (PSG) to determine optimal CPAP settings, 1,13 but no pediatric guidelines/metrics exist for clinical management for CPAP initiation or follow-up.…”