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Evaluation of the efficacy of a dedicated table to improve CPAP adherence in children: a pilot study
Alexis Mendoza-Ruiz1, Suela Dylgjeri2, Florence Bour2
1ASV Santé, Gennevilliers, France; Department of Neurosensory Function Tests, Hôpital de Gonesse, Gonesse, France.
Insights
A token economy table significantly improved continuous positive airway pressure (CPAP) adherence in children with obstructive sleep apnea. This simple intervention showed efficacy in increasing CPAP use over one month.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Behavioral Therapy
Background:
- Obstructive sleep apnea (OSA) in children often requires continuous positive airway pressure (CPAP) therapy.
- Poor adherence to CPAP therapy is a significant challenge in pediatric OSA management.
- Limited strategies exist to enhance CPAP adherence in pediatric populations.
Purpose of the Study:
- To evaluate the effectiveness of a token economy-based table intervention for improving CPAP adherence in children with OSA.
- To assess changes in CPAP usage duration and frequency after implementing the token economy table.
Main Methods:
- A token economy table was introduced to children with suboptimal CPAP use (<3 hours/night) approximately eight days after therapy initiation.
- Children recorded daily CPAP use with tokens (green for use, red for non-use).
- CPAP adherence was assessed one month after table implementation and compared to baseline and adherent children.
Main Results:
- Nonadherent children showed a significant increase in mean CPAP use to 4h31±1h12 per night (p < 0.001) after one month.
- Weekly adherence nights in nonadherent children approached that of adherent children (6.4±0.6 vs. 6.8±0.6 nights/week).
- While improved, mean adherence in nonadherent children remained lower than in the adherent group at one month (4h31±1h12 vs. 7h27±2h00).
Conclusions:
- A simple token economy table intervention can effectively improve CPAP adherence in children with OSA.
- This behavioral strategy offers a practical approach to enhance treatment compliance in pediatric sleep apnea.
- Further research may explore long-term adherence and broader implementation of such tools.
Objective:
Only a few studies have addressed strategies to improve continuous positive airway pressure (CPAP) adherence in children with obstructive sleep apnea. The aim of our study was to assess the efficacy of a table based on token economy to improve CPAP adherence.
Methods:
A table was proposed to children nonadherent to CPAP (<3 h per night of CPAP use), eight days after CPAP initiation (D8). The child has to fill the table on a daily basis with green (I used my CPAP this night) or red (I did not use my CPAP) tokens. Objectives of CPAP use and rewards were decided between the child and their parents. An assessment of CPAP adherence was performed one month after initiation of table filling (M1) and compared to CPAP adherence at D8, and to data of adherent children.
Results:
Data of six nonadherent and nine adherent children were gathered (age 5 ± 5 vs. 5 ± 3 years, p = 0.953; apnea-hypopnea index 20 ± 15 vs. 25 ± 16 events/h, p = 0.550, respectively). Mean CPAP adherence at D8 was 4.7 ± 1.6 nights/wk and 1h00 ± 0h33 in the nonadherent children, vs. 6.9 ± 0.4 nights/wk and 7h16 ± 1h51 in the adherent group (p < 0.01). The mean number of nights per week at M1 was 6.4 ± 0.6 nights in nonadherent children (p = 0.086), and was equivalent to that in adherent children (6.8 ± 0.6 nights, p = 0.126). Mean adherence at M1 increased to 4h31 ± 1h12 in non-adherent children (p < 0.001), but was still lower when compared to that in adherent children (7h27 ± 2h00, p = 0.007).
Conclusion:
The study findings imply that use of a simple table by a child appears to be effective in improving CPAP adherence at one month.
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