Open AccessFollow‐up and Time to Treatment in an Urban Cohort of Children with Sleep‐Disordered Breathing
Author(s) -
Harris Vandra C.,
Links Anne R.,
Kim Julia M.,
Walsh Jonathan,
Tunkel David E.,
Boss Emily F.
Publication year - 2018
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599818772035
Subject(s) - polysomnography , medicine , sleep apnea , obstructive sleep apnea , odds ratio , cohort , subspecialty , confidence interval , physical therapy , population , pediatrics , apnea , environmental health , psychiatry
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.