Follow‐up and Time to Treatment in an Urban Cohort of Children with Sleep‐Disordered Breathing. (24th April 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: 2018-04-24
• 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

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.