Exploring Barriers and Facilitators to Positive Airway Pressure Use Over Time Among Young Adults: A Qualitative Study

Objective: Effective treatment for Obstructive Sleep Apnea (OSA) in youth is challenging due to lack of adherence to Positive Airway Pressure (PAP). The study objective was to explore facilitators and barriers for PAP use among young adults with OSA transitioning from paediatric to adult care services. Methods: This was a prospective, qualitative study using a modified grounded theory approach. Young adults, aged 18 to 20 years, diagnosed with OSA by polysomnography and initiated on PAP therapy in a paediatric sleep facility participated in the study. Semistructured interviews were completed at: 1) baseline visit at the time of transfer from paediatric care and 2) follow-up visit after 12 months in adult care. Interview audio recordings were transcribed verbatim. Transcripts were reviewed, analysed and coded into themes related to barriers and facilitators to PAP. Results: Eighteen interviews were conducted: 10 at baseline and 8 at follow-up. During both visits, participants described the importance of health education, support, and perceived benefits including restfulness and alertness despite experiencing discomfort with PAP use. Several challenges were also highlighted, including managing the stigma associated with PAP use and the physical design of the machine such as the interface discomfort and lack of portability. Conclusion: Several facilitators and barriers to PAP adherence among young adults with OSA during transition were identified. Implementing an integrative healthcare approach with educational strategies and tools, family involvement and peer support is critical to optimize PAP use during young adulthood and the period of transition to adult care.