Positive Airway Pressure (PAP) devices are being increasingly used in pediatric populations for problems including Obstructive Sleep Apnea. There is limited literature regarding pediatric adherence with PAP treatment or successful interventions that improve adherence. This paper describes a clinical program for pediatric PAP users which was designed to improve adherence of patients prescribed PAP therapy and involves intensive assessment and behavioral intervention.
Method:
The design and implementation of the program is described, including the purpose, goals, programmatic structure, clinical content, type and training of personnel, strengths and limitations and financial concerns as well as the challenges with the development and application of the program’s protocol.
Results:
Preliminary outcome data show short-term improvements in consistent usage for many of the patients.
Conclusions:
The program shows some promise and provides a framework for future program development and research.
AloiaM. S.Di DioL.IlniczkyN.PerlisM. L.GreenblattD. W.GilesD. E. (2001). Improving adherence with nasal CPAP and vigilance in older adults with OSAHS. Sleep and Breathing, 5 (1), 13-21.
2.
AloiaM. S.ArnedtJ. T.RiggsR. LHechtJ.BorrelliB. (2004). Clinical management of poor adherence to CPAP: Motivational enhancement. Behavioral Sleep Medicine, 2 (4), 205-222.
3.
AloiaM. S.GoodwinM. S.VelicerW. F.ArnedtJ. T.ZimmermanM.SkrekasJ.. . .MillmanR. P. (2008). Time series analysis of treatment adherence patterns in individuals with Obstructive Sleep Apnea. Annals of Behavioral Medicine, 36 (1), 44-53.
4.
BrostromA.StrombergA.UlanderM.FridlundB.MartenssonJ.SvanborgE. (2009). Perceived informational needs, side effects and their consequences on adherence – A comparison between CPAP treated patients with OSAS and healthcare personnel. Patient Education and Counseling, 74, 228-235.
5.
EdingerJ. D.RadtkeR. A. (1993). Use of in vivo desensitization to treat a patient’s claustrophobic response to nasal CPAP. Sleep, 16 (7), 678-680.
6.
EnglemanH. M.MartinS. E.DouglasN. J. (1994). Adherence with CPAP therapy in patients with sleep apnoea/hypopnoea syndrome. Thorax, 49, 263-266.
7.
KoontzK. L.SliferK. J.CataldoM. D.MarcusC. L. (2003). Improving pediatric compliance with positive airway pressure therapy: The impact of behavioral intervention. Sleep, 26 (8), 1010-1015.
8.
KriegerJ.KurtzD.PetiauC.SforzaE.TrautmannD. (1996). Long-term adherence with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep, 19 (9), S136-143.
9.
LikarL. L.PancieraT. M.EricksonA. D.RoundsS. (1997). Group education sessions and adherence with nasal CPAP therapy. Chest, 111, 1273-1277.
10.
MarcusC. L.RosenG.Davidson WardS. L.HalbowerA. C.SterniL.. . .GordonN. (2006). Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics, 117, e442-e451.
11.
MindellJ. A.OwensJ. (2003) A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Philadelphia, PA: Lippincott Williams and Wilkins.
12.
MindellJ.A.OwensJ.A.2nd edition (2010). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Philadelphia, PA: Lippincott Williams and Wilkins.
13.
O’DonnellA. R.BjornsonC. L.BohS. G.KirkV. G. (2006). Compliance rates in children using noninvasive continuous positive airway pressure. Sleep, 29 (5), 651-658.
14.
ProchaskaJ. O.DiClementeC.C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
15.
SchechterM. S.Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. (2002). Technical report: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 109, E69, 1–20.
16.
SliferK. J.KruglakD.BenoreE.BellipanniK.FalkL.HalbowerA. C.. . .BeckM. (2007). Behavioral training for increasing preschool children’s adherence with positive airway pressure: A preliminary study. Behavioral Sleep Medicine, 5, 147-175.
17.
StepnowskyC. J.PalauJ. J.GiffordA. L.Ancoli-IsraelS. (2007). A self-management approach to improving continuous positive airway pressure adherence and outcomes. Behavioral Sleep Medicine, 5, 131-146.
18.
TsaraV.KaimakamisE.SerasliE.KatsarouZ.ChristakiP. (2009). Health related quality of life in Greek patients with sleep apnea-hypopnea syndrome treated with continuous positive airway pressure. Sleep Medicine, 10, 217-225.
19.
UongE. C.EppersonM.BathonS. A.JeffeD. B. (2007). Adherence to nasal positive airway pressure therapy among school-aged children and adolescents with Obstructive Sleep Apnea Syndrome. Pediatrics, 120 (5), e1203-e1211
20.
YoungT.PeppardP. E.TaheriS. (2005). Excess weight and sleep-disordered breathing. Journal of Applied Physiology, 99, 1592-1599.
