title: Role of a respiratory therapist in improving adherence to positive airway pressure treatment in a pediatric sleep apnea clinic.
abstract: BACKGROUND
  Many pediatric patients need positive airway pressure (PAP) for treatment of obstructive sleep-disordered breathing. Adherence to PAP (defined as percent of nights with PAP use of > 4 h) is often poor and not sustained long-term. With any chronic disease, education has been shown to help with patient outcomes. Education of patients and parents regarding PAP can be provided by different healthcare professionals. There is no published literature assessing the role of respiratory therapists (RTs) in improving adherence to PAP in children. We hypothesized that the addition of RT visits to a PAP clinic would improve PAP adherence.
  
  
  METHODS
  RT services for PAP patients were introduced in a multidisciplinary pediatric sleep clinic in May 2006. We identified children who had been followed in clinic, and had adherence download information before and after introduction of RT services. We collected demographic, polysomnography, and CPAP adherence data at clinic visits.
  
  
  RESULTS
  Forty-six subjects met criteria for inclusion. The mean ± SD age was 14.9 ± 6 y. The mean ± SD apnea-hypopnea index was 26.7 ± 30 events/h. Other than the addition of the RT intervention, all subjects continued to receive the same clinical services as before. Subjects were divided into 3 groups, based on baseline adherence: 0% use, use for 1-50% of nights, and use for > 50% of nights. There was a statistically significant improvement in PAP adherence in the subjects with baseline use of 0% and 1-50%, but no improvement in those with > 50% use at baseline. There was no significant change in PAP use at subsequent RT visits.
  
  
  CONCLUSIONS
  Utilization at clinic visits of an RT trained in the use of PAP improved adherence in pediatric subjects with obstructive sleep-disordered breathing when their baseline PAP adherence was < 50%.
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Supriya K
authors.initials: SK
authors.lastname: Jambhekar
authors.forename: Gulnur
authors.initials: G
authors.lastname: Com
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.forename: Kristi K
authors.initials: KK
authors.lastname: Pruss
authors.forename: Rithea
authors.initials: R
authors.lastname: Jackson
authors.forename: Charles
authors.initials: C
authors.lastname: Bower
authors.forename: John L
authors.initials: JL
authors.lastname: Carroll
authors.forename: Wendy
authors.initials: W
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities; D002648:Child; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000193:education / Q000523:psychology / Q000592:standards; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods; D024382:Professional Role; D011369:Professional-Patient Relations; D012891:Sleep Apnea Syndromes / Q000523:psychology / Q000628:therapy; D013192:Staff Development / Q000379:methods
keywords: CPAP; adherence; obstructive sleep apnea; patient education; pediatrics; respiratory therapy department