Facilitators and Barriers to Positive Airway Pressure Adherence for Adolescents. A Qualitative Study.

RATIONALE: Low adherence to positive airway pressure (PAP) treatment for adolescents with obstructive sleep apnea (OSA) can have long-term cardiometabolic and developmental impact.

OBJECTIVES: To explore the facilitators and barriers to PAP use in adolescents with OSA.

METHODS: We conducted a qualitative study using a descriptive thematic analysis approach. A total of 21 interviews were conducted in the clinical setting with adolescents prescribed PAP to treat OSA within the previous 12 months. Interview audio recordings were transcribed verbatim for analysis. Transcripts were reviewed, and data were categorized using a coding framework developed by the research team. Codes were structured into themes related to the barriers and facilitators to using PAP.

RESULTS: Participants described numerous challenges with the physical design of the PAP machine, including the restriction of the tubing, the discomfort of the mask, and concerns with its size and weight. A period of adjustment to wearing and preparing the PAP machine was described whereby participants had to develop their own strategies to improve comfort. After initiating the therapy, the challenges experienced by participants were cited more often than the perceived benefits, particularly for those who were less adherent. Finally, the unique needs of adolescents were highlighted, which impacted the amount of family support desired in using PAP.

CONCLUSIONS: This study identifies factors affecting PAP adherence when prescribed in adolescence and highlights the need for ongoing dialogue between adolescents and their clinical team with respect to challenges encountered, troubleshooting, adherence strategies, and parental engagement.