Positional obstructive sleep apnea treatments in children: A qualitative study

Background Positional obstructive sleep apnea (POSA) is a condition characterized by airway obstruction that is exacerbated during supine sleep. Treatments include adenotonsillectomy and positive airway pressure (PAP) therapy. Positional therapy is an emerging treatment option and refers to a wearable device that physically prevents supine sleep. Objective To explore the experiences and preferences of children and caregivers with POSA treatments, including adenotonsillectomy, PAP therapy, and positional therapy. Methods Semi-structured interviews were conducted with the caregivers of children aged 4-18 years old who participated in a trial that evaluated the efficacy of positional therapy in children. Children were invited to participate when possible. Interviews were coded by two reviewers using thematic analysis and themes were generated by the research team. Results Four children and 16 caregivers participated. Four themes were identified: (1) comfort and convenience, (2) symptom improvement, (3) emotional, psychological, and social aspects of treatment, and (4) shared decision-making. Positional therapy was considered the least burdensome of the three therapies. It was viewed as simple and minimally invasive but was limited by modest symptom improvement. PAP therapy provided symptom relief, but discomfort and poor tolerance were barriers to nightly use. Adenotonsillectomy was the only treatment with curative potential, but was sometimes viewed less favorably due to concerns about surgical risks. Conclusion Families have varied preferences regarding POSA treatments. Identifying priorities prior to treatment may improve treatment satisfaction. To optimize adherence to positional and PAP therapy in children, barriers such as sensory issues and setup and maintenance should be addressed.