Positional Therapy for the Treatment of Obstructive Sleep Apnea in Children: A Qualitative Study
Bibliographic record
Abstract
Abstract Background: Positional obstructive sleep apnea (POSA) is a form of obstructive sleep apnea where airway obstruction is exacerbated during supine sleep. Treatments for POSA include adenotonsillectomy, positive airway pressure (PAP) therapy, and positional therapy, an emerging treatment with an inflatable belt that physically prevents supine sleep. To date, little is known about the experiences of children and their caregivers with POSA treatment. Objective: This study aims to explore (1) the experiences and perspectives of children and caregivers on positional therapy and (2) their preferences for POSA treatment. Methods: We conducted semi-structured interviews with the caregivers of children with POSA aged 4-18 years old who participated in a randomised controlled trial evaluating the efficacy of positional therapy. Children were also invited to join the interviews. Interviews were audio recorded, transcribed verbatim, and coded by two independent reviewers using thematic analysis. Overarching themes were generated collaboratively. Results: Fifteen caregivers were interviewed including 5 caregiver-child dyads. The 15 children had a median age of 10.8 years (interquartile range 9.3, 16.1 years) at the time of the interview. Eight of 15 children (53%) were female, and 5/15 children (33%) had a previous adenotonsillectomy prior to entry into the trial. Emerging themes included: (1) comfort and convenience, (2) symptom improvement, (3) emotional, psychological, and social aspects of treatment, (4) shared decision-making, and (5) reaction to treatment options. Some participants preferred adenotonsillectomy due to its curative potential, but it was viewed as a last resort by others due to the risk of trauma and complications. While positional therapy was considered the least invasive, it had modest effects on sleep apnea symptoms. PAP therapy provided greater symptom relief and was seen as an alternative to adenotonsillectomy. However, barriers to PAP therapy included discomfort with therapy and the need for nightly implementation. Discussion: Values and priorities for the outcome of POSA treatment vary between families. These should be identified during initial consultations with healthcare providers to ensure satisfaction with treatment. To optimize adherence to PAP therapy and positional therapy in pediatric populations, sensory issues should be addressed, and the setup and maintenance process should be simplified.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.009 | 0.007 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".