Positional obstructive sleep apnea treatments in children: A qualitative study

Area of Science:

• Pediatric Sleep Medicine
• Respiratory Medicine
• Otolaryngology

Background:

• Positional obstructive sleep apnea (POSA) is worsened by supine sleep.
• Current treatments include adenotonsillectomy, positive airway pressure (PAP) therapy, and emerging positional therapy devices.
• Positional therapy aims to prevent supine sleep using wearable technology.

Purpose of the Study:

• To explore the experiences and preferences of children and caregivers regarding POSA treatments.
• To compare adenotonsillectomy, PAP therapy, and positional therapy from a patient and caregiver perspective.

Main Methods:

• Semi-structured interviews were conducted with caregivers of children (aged 4-18) involved in a positional therapy trial.
• Children were invited to participate when feasible.
• Thematic analysis was employed, with interviews coded by two reviewers and themes generated by the research team.

Main Results:

• Four children and 16 caregivers participated, identifying four key themes: comfort/convenience, symptom improvement, psychosocial aspects, and shared decision-making.
• Positional therapy was perceived as least burdensome and minimally invasive, though symptom improvement was modest.
• PAP therapy offered symptom relief but faced adherence challenges due to discomfort.
• Adenotonsillectomy, while potentially curative, raised concerns about surgical risks.

Conclusions:

• Family preferences for POSA treatments vary significantly.
• Aligning treatments with family priorities may enhance satisfaction.
• Addressing barriers like sensory issues and device management is crucial for improving adherence to positional and PAP therapy in pediatric patients.