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The Use of Computer Decision Support for Pediatric Obstructive Sleep Apnea Detection in Primary Care
Sarah M Honaker1,2, Ashley Street2, Ameet S Daftary1
1Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
A computer decision support system (CDSS) effectively identifies children at risk for obstructive sleep apnea (OSA) in primary care. Most children who snore meet guidelines for further OSA evaluation.
Area of Science:
- Pediatric Sleep Medicine
- Clinical Informatics
- Primary Care
Background:
- Obstructive sleep apnea (OSA) is a significant health concern in children.
- Early detection and referral are crucial for managing pediatric OSA.
- Primary care settings are key for initial screening and identification.
Purpose of the Study:
- To evaluate the outcomes of a computer decision support system (CDSS) for pediatric OSA detection in primary care.
- To determine the prevalence of children meeting referral criteria for OSA.
Main Methods:
- Implementation of a CDSS in two urban primary care clinics.
- Screening of children aged 2-11 for snoring, followed by additional OSA screening items.
- PCP prompts for snoring children, recommending OSA evaluation and referral.
Main Results:
- 18.7% of 2,535 children screened for snoring were identified as snorers.
- 40 (15.4%) of snoring children were referred by PCPs.
- 74.7% of snoring children met American Academy of Pediatrics criteria for OSA referral based on additional signs/symptoms.
Conclusions:
- A CDSS can effectively support primary care providers in identifying children at risk for OSA.
- The majority of snoring children meet established criteria for further OSA evaluation.
- Further research is needed to assess the referral threshold and sleep medicine field's capacity.
Study Objectives:
To (1) describe outcomes from a computer decision support system (CDSS) for pediatric obstructive sleep apnea (OSA) detection in primary care; and (2) identity the prevalence of children meeting criteria for an OSA referral.
Methods:
A CDSS for OSA was implemented in two urban primary care clinics. Parents of children (age 2 to 11 years) presenting to the clinic were asked if their child snored regularly, with a positive response resulting in six additional OSA screening items. Primary care providers (PCPs) received a prompt for all snoring children, listing applicable OSA signs and symptoms and recommending further evaluation and referral for OSA.
Results:
A total of 2,535 children were screened for snoring, identifying 475 snoring children (18.7%). Among snoring children, PCPs referred 40 (15.4%) for further evaluation. The prevalence of additional OSA signs and symptoms ranged from 3.5% for underweight to 43.7% for overweight. A total of 74.7% of snoring children had at least one additional sign or symptom and thus met American Academy of Pediatrics guidelines criteria for an OSA referral.
Conclusions:
A CDSS can be used to support PCPs in identifying children at risk for OSA. Most snoring children met criteria for further evaluation. It will be important to further evaluate this referral threshold as well as the readiness of the sleep medicine field to meet this need.
Clinical Trials Registration:
Registry: ClinicalTrials.gov, Title: Evidence-based Diagnosis and Management of Pediatric Obstructive Sleep Apnea in Primary Care, Identifier: NCT02781376, URL: https://clinicaltrials.gov/ct2/show/NCT02781376.
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