Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing. (August 2018)

• Record Type: Journal Article
• Authors: Harris, Vandra C.; Links, Anne R.; Kim, Julia M.; Walsh, Jonathan; Tunkel, David E.; Boss, Emily F.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 159:Number 2(2018)
• Page Start: 371
• Page End: 378
• Publication Date: 2018-08
• Subjects: sleep-disordered breathing -- obstructive sleep apnea -- polysomnography -- adenotonsillectomy -- treatment -- access to care -- health disparities -- socioeconomic status -- children -- pediatrics; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599818772035
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To evaluate follow-up and timing of sleep-disordered breathing diagnosis and treatment in urban children referred from primary care. Study Design: Retrospective longitudinal cohort analysis. Setting: Tertiary health system. Subjects and Methods: Pediatric outpatients with sleep-disordered breathing, referred from primary care for subspecialty appointment or polysomnography in 2014, followed for 2 years. Timing of polysomnography or subspecialty appointments, loss to follow-up, and sleep-disordered breathing severity were main outcomes. Chi-square and t -test identified differences in children referred for polysomnography, surgery, and loss to follow-up. Logistic regression identified predictors of loss to follow-up. Days to polysomnography or surgery were evaluated using the Kaplan-Meier estimator, with Cox regression comparing estimates by polysomnography receipt and disease severity. Results: Of 216 children, 188 (87%) had public insurance. Half (109 [50%]) were lost to follow-up after primary care referral. More children were lost to follow-up when referred for polysomnography (50 [76%]) compared with subspecialty evaluation (35 [32%]; P < .001). Children referred to both polysomnography and subspecialty were more likely to be lost to follow-up (odds ratio = 2.73, 95% confidence interval = 1.29-5.78; P = .009). For children who obtained polysomnography, an asymmetric distribution of obstructive sleep apnea severity was not observed ( P = .152). Median time to polysomnography and surgery was 75 and 226 days, respectively. Obstructive sleep apnea severity did not influence time to surgery ( P = .410). Conclusion: In this urban population, half of the children referred for sleep-disordered breathing evaluation are lost to follow-up from primary care. Obstructive sleep apnea severity did not predict follow-up or timeliness of treatment. These findings suggest social determinants may pose barriers to care in addition to the clinical burden of sleep-disordered breathing.