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Lost to follow-up: Post-operative polysomnography in at-risk, pediatric obstructive sleep apnea
Benjamin Long1, Alex McKinlay1, Subodh Arora1
1San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA.
Insights
Post-operative polysomnography adherence in pediatric obstructive sleep apnea (OSA) patients varies. Recurrent symptoms and severe OSA increase adherence, but a standardized care pathway is needed for at-risk children.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is common in children, often requiring surgical intervention.
- Post-operative polysomnography (PSG) is recommended by the American Academy of Sleep Medicine (AASM) to assess surgical success.
- Adherence to post-operative PSG guidelines in pediatric OSA remains unclear.
Purpose of the Study:
- To analyze adherence to AASM recommendations for post-operative polysomnography in pediatric patients with moderate-to-severe obstructive sleep apnea.
- To identify factors associated with completing post-operative polysomnography after surgical intervention for pediatric OSA.
Main Methods:
- Retrospective cohort study of pediatric patients (ages 1-17) with moderate-to-severe OSA who underwent surgical intervention.
- Chart review included demographic data, comorbidities, provider encounters, and timing of follow-up and post-operative polysomnography.
- Analysis focused on adherence to post-operative PSG and factors influencing completion.
Main Results:
- Of 373 patients, 67 met inclusion criteria; 21 completed post-operative PSG.
- Patients with residual/recurrent symptoms (p < 0.01) and severe OSA (p = 0.04) were more likely to complete post-operative PSG.
- Patients with severe OSA and comorbidities were more likely to complete PSG than those with isolated moderate OSA (p = 0.01).
Conclusions:
- Recurrent symptoms and increased OSA severity are associated with post-operative PSG completion in pediatric patients.
- Significant variability exists in post-operative PSG adherence, suggesting inconsistent standards and uncoordinated care.
- A standardized, multi-disciplinary care pathway is recommended for managing at-risk pediatric OSA patients post-surgery.
Objective:
Analyze adherence to AASM recommendations for post-operative polysomnography in eligible pediatric patients.
Study Design:
Retrospective Cohort.
Setting:
Tertiary, Outpatient Sleep Lab.
Methods:
We conducted a retrospective analysis of pediatric patients, ages 1-17, previously diagnosed with moderate-severe obstructive sleep apnea that completed a surgical intervention. Chart review included demographic data, a co-morbidity of interest, the presence of an otolaryngology, primary care, or sleep medicine encounter, time to follow-up, the presence of a post-operative polysomnography, time to post-operative polysomnography, and the presence of an annual follow-up with any provider.
Results:
Of the 373 patients, 67 patients met inclusion criteria. Fifty-nine followed-up with any provider, with 21 completing post-operative polysomnography. Patients with residual or recurrent symptoms (p < 0.01) and all patients with severe obstructive sleep apnea (p = 0.04) were more likely to complete post-operative polysomnography (PSG). Sub-analysis across at-risk categories (isolated moderate, isolated severe, moderate & a co-morbidity, and severe & a co-morbidity) revealed patients with severe obstructive sleep apnea & a co-morbidity completed a follow-up PSG more often than isolated moderate obstructive sleep apnea (p = 0.01). There was a difference in follow-up with sleep medicine across at-risk categories (p < 0.01).
Conclusion:
Recurrent symptoms and increasing disease severity were associated with obtaining post-operative polysomnography. However, variability existed for which patients completed post-operative polysomnography. We speculate an inconsistent standard across disciplines, inadequate post-operative obstructive sleep apnea management education, and uncoordinated systemic processes contribute to this discrepancy. Our findings support a standardized, multi-disciplinary care pathway for the management of at-risk, pediatric obstructive sleep apnea.
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