No Easy Way Down

This chapter reviews the evaluation and treatment of a 7-year-old girl with Down syndrome who had difficulty tolerating positive airway pressure (PAP) therapy. Children with Down syndrome are at high risk for symptomatic residual obstructive sleep apnea after AT. Treating children, especially those with developmental delays, behavior problems, and/or anxiety, with PAP requires patience, flexibility, and ingenuity. PAP therapy can be particularly challenging in children with tactile aversion. Gradual exposure to the mask and machine (operant conditioning) can facilitate habituation. PAP practice sessions should start with an enjoyable calming activity so the child begins to associate PAP with pleasant positive experiences. Maternal education about the indications for, risks or, and benefits of PAP to treat sleep apnea in children was the best predictor of mean hours used per night.