Caregiver-implemented intervention to increase use of positive airway pressure for adults with Down syndrome and sleep apnea.

Many individuals with Down syndrome are diagnosed with obstructive sleep apnea (OSA), a medical condition that substantially affects health and quality of life. The most common treatment for OSA is positive airway pressure (PAP) therapy. Few studies have examined interventions to improve PAP therapy adherence for adults with developmental disabilities or have recruited the assistance of caregivers to improve adherence with this therapy in the home. This study evaluated the efficacy of a caregiver-implemented behavioral intervention to increase PAP use for four adults with Down syndrome and OSA. The experimenters trained caregivers via telehealth to implement the intervention in their homes. The intervention consisted of graduated exposure, noncontingent reinforcement, and differential positive and negative reinforcement without escape extinction. The intervention increased the duration of PAP use for all four participants. These results provide preliminary support for the efficacy of this intervention and service-delivery model.