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

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

Fingerprint Dive into the research topics of 'Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing'. Together they form a unique fingerprint.

  • Cite this