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Unexplained Practice Variation in Primary Care Providers' Concern for Pediatric Obstructive Sleep Apnea
Sarah Morsbach Honaker1, Tamara Dugan2, Ameet Daftary1
1Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind.
Academic Pediatrics
|February 3, 2018
Summary
Primary care providers (PCPs) rarely suspect obstructive sleep apnea (OSA) in children, with screening influenced by provider factors, not child health. Many at-risk children remain undiagnosed, highlighting the need for improved PCP identification strategies for pediatric OSA.
Area of Science:
- Pediatric Sleep Medicine
- Primary Care Screening Practices
- Obstructive Sleep Apnea (OSA) Diagnosis
Background:
- Obstructive sleep apnea (OSA) is a common condition in children, yet screening and diagnosis in primary care settings can be challenging.
- Primary care providers (PCPs) play a crucial role in identifying children who may have OSA, but current screening practices and their predictors are not well understood.
Purpose of the Study:
- To evaluate the screening practices of PCPs for obstructive sleep apnea (OSA) in children.
- To identify factors that predict PCP screening habits for OSA.
- To assess the completion rate and outcomes of polysomnography referrals for suspected pediatric OSA.
Main Methods:
- A computer-based decision support system for snoring screening was implemented in five urban primary care clinics.
- 1086 children aged 1-11 years with snoring were studied, with data collected on child demographics, health characteristics, and provider/clinic factors.
- Logistic regression analysis was used to determine predictors of PCP suspicion for OSA.
Main Results:
- PCPs suspected OSA in only 20% of snoring children, with significant variation between clinics and providers.
- Provider training, years of experience, and child age were significant predictors of OSA suspicion, while child health factors like obesity were not.
- Of 100 children referred for polysomnography, 61% completed the study, and 67% of those diagnosed with OSA.
Conclusions:
- There is considerable unexplained variation in PCP screening for pediatric OSA, suggesting many at-risk children are missed.
- Current screening practices appear influenced more by provider characteristics than by objective patient health factors.
- Further research and interventions are needed to enhance PCP-led identification of OSA in children.