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Sleep. 2003 Dec 15;26(8):1010-5.

Improving pediatric compliance with positive airway pressure therapy: the impact of behavioral intervention.

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The Kennedy Krieger Institute, Johns Hopkins University School of Medicine, USA.



The purposes of this study were (1) to describe behavior interventions provided to improve compliance with positive airway pressure (PAP) therapies in children with obstructive sleep apnea, (2) to survey physician and caregiver satisfaction with these interventions, and (3) to present preliminary outcome data on the effects of these interventions.


Retrospective, descriptive analysis.


Pediatric psychology consultation service at a university-affiliated rehabilitation hospital.


20 children (aged 1-17 years) with obstructive sleep apnea, referred by physicians for noncompliance with PAP.


Patients self-selected into 1 of 3 groups: (1) a group receiving a 1.5-hour consultation and recommendation session (CR+), (2) a group receiving consultation and recommendations plus a course of behavior therapy (BT), and (3) a group for whom behavior therapy was recommended after the consultation and recommendations, but the family did not follow-up (CR-).


Prior to behavior intervention, none of the children were consistently wearing the PAP equipment. After intervention, 75% of children who received behavior intervention (CR+ and BT groups) successfully tolerated PAP with increased hours of documented usage. This was in contrast to children whose families declined recommended behavior therapy (CR- group), of whom 0% increased their usage of PAP. High satisfaction ratings were obtained from referring physicians and patient caregivers for children in the CR+ and BT groups.


The results are encouraging and support the importance of behavior analysis and therapy for increasing compliance and making the benefits of PAP available to a greater number of children.

[Indexed for MEDLINE]

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