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Screening for sleep disorders in pediatric primary care: are we there yet?
Daniel Erichsen1, Cecilia Godoy, Fanny Gränse
1Albert Einstein College of Medicine, St Barnabas Hospital, Astoria, NY 11105, USA. danie.erichsen@gmail.com
Insights
Pediatricians rarely screen for snoring or sleep-disordered breathing (SDB), leading to low adherence to American Academy of Pediatrics (AAP) guidelines. This limits the detection and treatment of obstructive sleep apnea (OSA) in children.
Area of Science:
- Pediatric Medicine
- Sleep Medicine
- Public Health
Background:
- Childhood obstructive sleep apnea (OSA) and habitual snoring are common and linked to adverse health outcomes.
- The American Academy of Pediatrics (AAP) issued guidelines a decade ago for routine screening of sleep-disordered breathing (SDB) in primary care.
- Implementation and effectiveness of these AAP guidelines in pediatric primary care remain unclear.
Purpose of the Study:
- To assess adherence to AAP guidelines for SDB screening in pediatric primary care.
- To determine the extent of SDB screening in children aged 4-17 years.
Main Methods:
- Manual review of 1032 electronic charts of children aged 4-17 years from well-child visits.
- Data abstracted included demographics and documentation of snoring or other sleep complaints.
- Study conducted between January 1 and December 31, 2010.
Main Results:
- Only 24.4% of children were screened for snoring.
- Of those screened, 34.1% snored, but 61.6% received no further evaluation.
- The diagnosed prevalence of OSA was very low at 0.5%.
Conclusions:
- Low screening rates and poor adherence to AAP guidelines contribute to underdiagnosis of SDB and OSA in children.
- Improvements may involve electronic medical record modifications and enhanced education for healthcare providers and caregivers.
- Early detection and treatment of SDB are crucial for mitigating negative health outcomes in at-risk children.
Objectives:
Obstructive sleep apnea (OSA) and habitual snoring are highly prevalent childhood conditions and have been associated with a large array of negative health outcomes. Although guidelines were published by the American Academy of Pediatrics (AAP) a decade ago recommending routine screening of sleep-disordered breathing (SDB) in primary care settings, it remains unclear to what extent such guidelines have been implemented and resulted in effective SDB screening. The aim of this study was to determine if AAP guidelines are adhered to in pediatric primary care.
Study Design:
In all, 1032 electronic charts of children 4 to 17 years old presenting for well-child visits to 17 pediatricians between January 1 and December 31, 2010, were manually reviewed. Abstracted data included demographic variables and documentation of snoring as well as other sleep-related complaints.
Results:
The mean age was 8.5 ± 3.9 years (mean ± standard deviation), 49.9% were male, and 79.7% were Hispanic; 24.4% (n = 252) were screened for snoring. Of the children screened for sleep-related issues, 34.1% (n = 86) snored, but the majority of them (61.6%, n = 53) received no further evaluation. In the present sample, 0.5% (n = 5) had a diagnosis of OSA.
Conclusions:
The low prevalence of OSA may be explained by the relatively low frequency of sleep-related problem screening by pediatricians and thus the inordinately low adherence to the AAP guidelines. Modification and transition to electronic medical records as well as expanded efforts to educate health care providers and caregivers may improve detection and timely treatment of children at risk for SDB.
