Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

Abstract

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...

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…c) Retrospective studies have reported adverse effects of positive airway pressure treatment in children with OSAS (class IV) [238,241]. d) Objective patient adherence has been evaluated in class I-IV studies and may vary from low to quite high (>8 h per night for >70% of patients) regardless of the use of CPAP or NPPV [235,237,238,[242][243][244]. Factors associated with better patient adherence include the degree of improvement in the AHI, overall perception of benefits from treatment, family structure and maternal education (class IV) [237,243,245].…”

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

“…This finding is important for clinical management and suggests that, even in obese adolescents, adenotonsillectomy should be considered as an initial treatment for OSAS. This is particularly important when one considers that in this age group CPAP adherence tends to be poor (48,49) and achieving weight loss is very difficult. However, further clinical studies, including pre-and postoperative polysomnography, are needed to confirm the results of this study in the adolescent population.…”

Pediatric Positive Airway Pressure Adherence in Obstructive Sleep Apnea Enhanced by Family Member Positive Airway Pressure Usage

“…4 Among family-related factors, higher maternal education, 4 better home structure, and communication have been associated with increased usage. 11 Identification of factors that operate to enhance PAP adherence in children is key as such knowledge will inform the development of strategies to optimize OSA treatment, thereby translating BRIEF SUMMARY Current Knowledge/Study Rationale: Positive airway pressure (PAP) is long term therapy for children with obstructive sleep apnea (OSA) that persists after adenotonsillectomy or who are not candidates for that surgery, but its efficacy is limited by suboptimal adherence in this age group. The study explored whether having a family member on PAP therapy was associated with better PAP adherence in the child.…”