Adenotonsillectomy is considered the first-line treatment for obstructive sleep apnea syndrome (OSAS), although not all patients are surgical candidates and some continue to have symptoms after surgery. Positive airway pressure is effective in treating OSAS in these patients by pneumatically splinting the upper airway. Its efficacy is predicated on using the device as prescribed, but adherence is difficult to achieve in both adults and children. Numerous factors are thought to contribute to PAP nonadherence in children. Measures proposed to overcome barriers to adherence include child/parent engagement in PAP treatment, education regarding potential side effects, troubleshooting support, and specific behavioral interventions.