Participation of children with obstructive sleep apnea in clinical trials: a systematic review of barriers and interventions.

BACKGROUND: Obstructive sleep apnea (OSA) has negative effects on neurocognitive development and metabolic health in children. Despite this, children with OSA remain underrepresented in research; consequently, most evidence on treatment is based on adult data. This review focuses on studies assessing barriers to clinical trial participation in children with OSA and discusses intervention studies and efforts to overcome these barriers. METHODS: We retrieved articles from Scopus, Embase, PubMed, and the Cochrane Library without date restrictions until February 2026. The language used was restricted to English. The Joanna Briggs Institute (JBI) tool was used to assess methodological quality. RESULTS: Of the 28 included studies, 14 barrier subcategories were identified across three domains: objective factors (25 studies), provider factors (6 studies), and patient/caregiver factors (25 studies). The most frequently reported barriers were stringent eligibility criteria, refusal of follow-up, treatment disagreement, and health problem. CONCLUSIONS: Our findings emphasize multifaceted barriers to enrolling children with OSA in clinical trials. Furthermore, we provided several underutilized solutions to facilitate children's participation in clinical trials. However, formal targeted strategies are still needed in the future, because these recommendations alone might not solve the evidence gap in children.