Adherence to positive airway pressure therapy in adults and children

Positive airway pressure (PAP) therapy is commonly prescribed treatment for obstructive sleep apnea (OSA) in both adults and children. However, the effectiveness of PAP therapy is undermined by poor adherence. The purpose of this review is to improve our understanding of the causes and consequences of nonadherence to PAP therapy and highlight interventions that promote adherence.

Nonadherence to PAP therapy is associated with higher levels of sleepiness and greater likelihood for cardiovascular morbidity and mortality. Factors consistently associated with nonadherence to PAP therapy include asymptomatic individuals, nasal obstruction, low self-efficacy, lack of risk perception, and lower socioeconomic status. Care by certified specialists and accredited centers may be associated with better adherence but this finding needs to be replicated. Interventions such as cognitive-behavioral therapy, intensive education and support, and reduction of nasal obstruction have been consistently shown to augment adherence to therapy, whereas the benefits of device or interface modifications are less clear. There is a paucity of investigations addressing PAP therapy adherence in children.

Nonadherence limits the effectiveness of PAP therapy in both adults and children. Whereas the causes and consequences of poor adherence to PAP therapy and the ramifications to healthcare delivery are better understood, there remains a dearth of reliable and cost-effective interventions.