An Overview and Application of Evidence-Based Interventions to Improve Adherence to Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea

Objective: The purpose of this manuscript is to provide an overview of evidence-based strategies designed to promote adherence to and self-management of positive airway pressure (PAP) for the treatment of pediatric obstructive sleep apnea syndrome (OSAS) with an emphasis on those who are disproportionately impacted by OSAS. Methods: Utilized four recently published review articles and a book chapter, as well as a search of the literature since the most recent scoping review was published, to identify factors impacting pediatric adherence to PAP. Proposed conceptual models for self-management and adherence were also evaluated and strategies addressing factors within the context of these models were reviewed for application. Results: Evidence-based cognitive-behavioral strategies within a bio-socioecological framework and interdisciplinary team-based model are presented. A case study highlights the application of these interventions using an interdisciplinary coordinated care model, including clinical outcome data (e.g., objective adherence measures from the PAP device). Conclusions: Existing evidence supports a family-centered interdisciplinary approach to initiating PAP and supporting long-term PAP adherence for the treatment of pediatric OSAS. A bio-socioecological framework provides structure for assessment and flexibility in which interventions, such as education, cognitive-behavioral strategies, and social support, can be tailored to the unique needs of each child and family.