Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing

Vandra C. Harris, Anne R. Links, Julia Minjung Kim, Jonathan Walsh, David E Tunkel, Emily Boss

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StateAccepted/In press - Apr 1 2018

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Polysomnography
Sleep Apnea Syndromes
Lost to Follow-Up
Primary Health Care
Obstructive Sleep Apnea
Therapeutics
Appointments and Schedules
Aftercare
Urban Population
Chi-Square Distribution
Insurance
Cohort Studies
Outpatients
Referral and Consultation
Retrospective Studies
Logistic Models
Odds Ratio
Confidence Intervals
Pediatrics
Health

Keywords

  • access to care
  • adenotonsillectomy
  • children
  • health disparities
  • obstructive sleep apnea
  • pediatrics
  • polysomnography
  • sleep-disordered breathing
  • socioeconomic status
  • treatment

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{362e25e5f2a94975b5e5e8a55bd38e36,
title = "Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing",
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.",
keywords = "access to care, adenotonsillectomy, children, health disparities, obstructive sleep apnea, pediatrics, polysomnography, sleep-disordered breathing, socioeconomic status, treatment",
author = "Harris, {Vandra C.} and Links, {Anne R.} and Kim, {Julia Minjung} and Jonathan Walsh and Tunkel, {David E} and Emily Boss",
year = "2018",
month = "4",
day = "1",
doi = "10.1177/0194599818772035",
language = "English (US)",
journal = "Otolaryngology - Head and Neck Surgery",
issn = "0194-5998",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing

AU - Harris, Vandra C.

AU - Links, Anne R.

AU - Kim, Julia Minjung

AU - Walsh, Jonathan

AU - Tunkel, David E

AU - Boss, Emily

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

KW - access to care

KW - adenotonsillectomy

KW - children

KW - health disparities

KW - obstructive sleep apnea

KW - pediatrics

KW - polysomnography

KW - sleep-disordered breathing

KW - socioeconomic status

KW - treatment

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U2 - 10.1177/0194599818772035

DO - 10.1177/0194599818772035

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JO - Otolaryngology - Head and Neck Surgery

JF - Otolaryngology - Head and Neck Surgery

SN - 0194-5998

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