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Obstructive sleep apnea (OSA) presents in 2-5 % of youth and has been consistently linked to sleepiness, cognitive deficits, behavior difficulties, and cardiovascular morbidity. PAP effectively treats OSA, however, nonadherence is the most common cause of PAP treatment failure in children. Few adherence interventions have been empirically studied for youth with OSA. The STARS (Steps Towards Achieving Restful Sleep) Clinic is a behavioral program to optimize child tolerance to PAP therapy through a parent class, and in vivo practice. The goal of the study was to examine parent knowledge and self-efficacy following participation in STARS, and associations with subsequent PAP adherence. Methods A retrospective chart review was conducted for patients in the STARS program. Items queried included patient demographics, diagnostic and treatment characteristics, pre- and post- STARS responses to a parent self-efficacy and knowledge questionnaire, and polysomnography and PAP adherence data. Paired-samples t-tests examined changes in parent self-efficacy and knowledge pre- to post STARS, and regression analyses examined associations between self-efficacy and knowledge with demographics, treatment-related characteristics, and PAP adherence. Results 130 patients completed the STARS program from October 2016 to February 2019. Participants were 8.3 years old ±6.3, 63% male, 57% white, 33% Hispanic, with severe OSA (OAHI =22 ±33). Most participants (87%) had at least one medical comorbidity (e.g, Down Syndrome, 41%). Both parent knowledge and self-efficacy increased significantly from pre- to post- STARS. Approximately 60% of patients were adherent following STARS (defined as ≥4 h use and ≥70% of days used). Higher post- knowledge, but not efficacy score, was significantly associated with better PAP adherence. Conclusion Parent knowledge and self-efficacy for PAP improved following the STARS program, and greater knowledge was associated with better adherence. Future research evaluating the efficacy and effectiveness of the STARS program is needed but preliminary evidence suggests it may be a promising model for improving youth PAP adherence. Support None

sleep

0886 Changes in Parent Knowledge and Self-Efficacy and Association With Adherence Following the Steps Towards Achieving Restful Sleep (STARS) Pediatric PAP Therapy Desensitization Program