Innovative Program Helps Pediatric Patients Adjust to PAP Therapy

Patients newly diagnosed with obstructive sleep apnea and those who struggle with positive airway pressure (PAP) usage at Arkansas Children’s Pediatric Sleep Disorders Center receive technical, psychological and behavioral support through the PAP adherence program.  

"This program makes our sleep center special. It is only available in a few sleep centers worldwide," said Supriya Jambhekar, M.D., medical director of the Pediatric Sleep Disorders Center at Arkansas Children's Hospital (ACH) and a professor of pediatric pulmonology at the University of Medical Sciences (UAMS).  

Holistic Approach 

The Arkansas Children’s Pediatric Sleep Disorders Center is the only one in the state and one of only a few pediatric hospitals nationwide with full-service accreditation from the Association of Sleep Disorders Centers through the American Academy of Sleep Medicine (AASM).   

It diagnoses and treats several sleep disorders in children, including obstructive sleep apnea, insomnia, restless legs syndrome, parasomnias and circadian rhythm disorders.  

Specialized PAP therapy for OSA patients is a priority for the center.  

"One of our nurses calls patients initiated on CPAP to check on usage and identify barriers. We have 1.5 dedicated respiratory therapist FTEs to help follow up with OSA patients," Jambhekar said. "Every child with a clinic visit for OSA meets with a respiratory therapist, which helps with troubleshooting and education regarding PAP. Not many sleep centers have this service."   

This multidisciplinary approach is unique.  

"This level of service is exceptional and not commonly available in many sleep centers, where resources such as respiratory therapists are often limited to the sleep lab rather than extended into the clinic setting," said Respiratory Care Services Clinical Manager April Scribner, M.S., RRT, RRT-SDS, CPFT, CHES. "While attending the national sleep meetings throughout the years, I have yet to meet another center that utilizes respiratory therapists in the clinic setting as we do. Proactive approaches such as identifying potential barriers to PAP use help us to address issues early and improve adherence."  

Desensitization Techniques  

For an age-appropriate approach for young patients, the team develops individualized treatment plans that may include CPAP machines for sleep apnea, medication for sleep disorders and lifestyle or behavioral modifications.    

Medical psychologists help young patients prepare for a sleep study and the use of a CPAP or BiPAP through desensitization techniques. Pediatric patients replicate the sleep study at home, utilizing everyday items like rubber bands and strings for "leads" and stickers or Band-Aids for the medical tape used to secure the leads. For a CPAP or BiPAP, a psychologist may have the child practice by putting the mask on a doll or their parent or caregiver or reading a story about a CPAP. It could also mean wearing it while watching a favorite T.V. or reading a favorite book.    

The team also offers inpatient desensitization services.  

“This has been a successful strategy for helping children acclimate to PAP therapy in a supportive, controlled environment where they can gradually adjust to treatment,” Scribner said.  

Arkansas Children's experts have found these techniques and programs reduce the child's stress, increase their cooperation and improve their experience with medical procedures and potentially future medical experiences. It can also allow for a more valid assessment. This work is vital for children who have sensory issues and trouble with medical procedures.   

"We can avail the services of sleep psychologists to help with CPAP use even in patients not enrolled in the PAP adherence program," Jambhekar said. "We can also utilize a social worker to help us with CPAP adherence."   

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