1 Division of Adolescent Medicine and.
2 Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and.
Ann Am Thorac Soc. 2018 Jan;15(1):83-88. doi: 10.1513/AnnalsATS.201706-472OC.
Low adherence to positive airway pressure (PAP) treatment for adolescents with obstructive sleep apnea (OSA) can have long-term cardiometabolic and developmental impact.
To explore the facilitators and barriers to PAP use in adolescents with OSA.
We conducted a qualitative study using a descriptive thematic analysis approach. A total of 21 interviews were conducted in the clinical setting with adolescents prescribed PAP to treat OSA within the previous 12 months. Interview audio recordings were transcribed verbatim for analysis. Transcripts were reviewed, and data were categorized using a coding framework developed by the research team. Codes were structured into themes related to the barriers and facilitators to using PAP.
Participants described numerous challenges with the physical design of the PAP machine, including the restriction of the tubing, the discomfort of the mask, and concerns with its size and weight. A period of adjustment to wearing and preparing the PAP machine was described whereby participants had to develop their own strategies to improve comfort. After initiating the therapy, the challenges experienced by participants were cited more often than the perceived benefits, particularly for those who were less adherent. Finally, the unique needs of adolescents were highlighted, which impacted the amount of family support desired in using PAP.
This study identifies factors affecting PAP adherence when prescribed in adolescence and highlights the need for ongoing dialogue between adolescents and their clinical team with respect to challenges encountered, troubleshooting, adherence strategies, and parental engagement.
青少年阻塞性睡眠呼吸暂停（OSA）患者对气道正压通气（PAP）治疗的依从性低，可能会对其长期的心脏代谢和发育产生影响。
探讨青少年 OSA 患者使用 PAP 的促进因素和障碍。
我们采用描述性主题分析方法进行了一项定性研究。共对 21 名在过去 12 个月内被处方 PAP 治疗 OSA 的青少年进行了临床环境下的访谈。对访谈的音频记录进行了逐字转录，以便进行分析。对转录本进行了审查，并使用研究团队开发的编码框架对数据进行了分类。代码被组织成与使用 PAP 的障碍和促进因素相关的主题。
参与者描述了 PAP 机物理设计方面的许多挑战，包括管道的限制、面罩的不舒适感以及对其大小和重量的担忧。参与者描述了一段调整佩戴和准备 PAP 机的时期，在此期间，他们必须开发自己的策略来提高舒适度。在开始治疗后，参与者所经历的挑战比感知到的益处更常被提及，特别是对那些依从性较差的患者。最后，强调了青少年的特殊需求，这影响了他们在使用 PAP 时所需的家庭支持程度。
本研究确定了在青少年中开具 PAP 时影响其依从性的因素，并强调了青少年及其临床团队之间需要就所遇到的挑战、故障排除、依从性策略以及家长参与进行持续对话。
