Telehealth Training of Caregivers to Increase PAP Machine Use in Adults with Down syndrome



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A common sleep disorder among individuals with Down syndrome is obstructive sleep apnea (OSA). The most common treatment of OSA is Positive Airway Pressure (PAP) therapy. However, adherence to PAP therapy prescriptions is low. The high prevalence of OSA and low adherence with PAP therapy emphasized the need for an intervention to increase PAP machine use in individuals with DS. The following study evaluated a caregiver-implemented behavioral intervention aiming to increase PAP machine use in adults with DS using a multiple baseline across participants design. Participants in this study included three adults diagnosed with DS and OSA. The researchers utilized behavioral skills training via videoconferencing software to train the caregivers to implement the intervention. The intervention included the use of graduated exposure to the PAP therapy (i.e., slow progression of steps leading up to 4 hours of PAP machine use), differential negative reinforcement (i.e., longer breaks following compliance, shorter breaks following noncompliance with the graduated exposure step), contingent positive reinforcement (i.e., rewards following compliance with the graduated exposure step) and noncontingent positive reinforcement (i.e., access to a leisure item during intervention sessions). This caregiver-implemented behavioral intervention was effective at increasing PAP machine use for all participants. The results of this study serve as preliminary results for the effectiveness of this behavioral intervention when implemented by caregivers.



Positive airway pressure therapy, adherence, graduated exposure, Down syndrome, sleep apnea, PAP machine, telehealth, caregiver training