0889 IDENTIFYING BARRIERS TO CPAP ADHERENCE IN THE PEDIATRIC POPULATION

Abstract

Introduction: Non-invasive ventilation with positive airway pressure (PAP) has been shown to be an effective treatment for obstructive sleep apnea in pediatric patients. However, poor adherence is common and contributes to the cardiovascular, neurocognitive and behavioral morbidities associated with untreated OSA. Identifying perceived barriers to the use of PAP, will allow the opportunity to create specific interventions to address such barriers and improve adherence. Methods: As part of our CPAP Quality Improvement Program, the adherence barriers to CPAP questionnaire (ABCQ) (Simon 2011) has been administered to patients requiring PAP and their parents at Cincinnati Children's Hospital starting in March 2016. The ABCQ consists of 31 questions related to PAP use on a five-point, Likert-type scale consisting of never, rarely, sometimes, often and very often. The questionnaire can be classified into 5 domains based on the perceived barrier to PAP use: affective, behavioral, cognitive, environmental and physical. Responses considered as the most important barriers to address were answered with “often” or “very often”. Results: To date, 35 questionnaires have been completed by caregivers (c) and 29 by patients (p). Questions within the domains “affective” or “physical” were most frequently given for not using PAP. The most frequent response patients gave was they “can be healthy without it”. 31%, versus 11% of caregivers. Thirty percent of caregivers and 25% of patients reported they “don't feel like using” PAP. Twenty-one percent of both patients and caregivers reported “embarrassment” as a barrier. The “hassle of using PAP” was reported in 24% of patients and 17% of caregivers. Other frequently reported barriers included not using it when they “don't feel well” (21% (p), 22% (c)), “makes them feel sick” (17% (p), 18% (c)), and causes a “stuffy nose” (10% (p), 17% (c). Conclusion: Despite multiple interventions in our CPAP adherence program, the ABCQ has helped identify additional barriers, especially in the affective, behavioral and cognitive domains, to CPAP usage. These barriers may explain why we have had difficulty improving our CPAP adherence. We are currently designing interventions to address these barriers including targeted education and better integration of behavior sleep psychologist.