Evidence-based Diagnosis and Management of Pediatric OSA Syndrome in Primary Care

2016 Strategic Research Award

Sarah Honaker, PhD, CBSM
Indiana University

Key Project Outcomes

Obstructive sleep apnea (OSA) is a sleep disorder that affects 2-4% of children. Children with OSA struggle to breathe well during the night, and often experience daytime symptoms such as sleepiness, behavior and mood difficulties, and worse overall health. OSA can be diagnosed with an overnight sleep study, and most children no longer have sleep apnea after a minor surgery. Unfortunately, many children with OSA remain unidentified, as their parents may not know about OSA and their primary care providers may not ask about OSA symptoms.

The purpose of this study was to develop and test a computerized system in primary care clinics to help identify more children who might have OSA. In this system (called CHICA OSA), parents of children between the ages of 2 and 12 years were some questions about their child’s sleep on an electronic tablet in the waiting room at the doctor’s office. If parents reported that their child had symptoms of OSA, such as regular snoring, primary care providers received a message in their electronic health record. This message informed the provider that the child had symptoms of OSA and recommended referring the child for a sleep study or for treatment.

To test this system, we randomly selected two primary care clinics to use CHICA OSA. In two similar clinics, we used a more basic system that only let providers know when a child snored. Over a period of 18 months, we collected data on how often providers referred children for OSA in the clinics. Before our study, the clinics were referring children for OSA at similar rates (about 10 per 1000 children). During the study, clinics using CHICA OSA referred children at a higher rate (about 19 per 1000 children) whereas the other clinics did not have a change in their referral rates.

Overall, we learned that systems like CHICA OSA can help parents and primary care providers identify children who may have OSA. However, even with a system like CHICA OSA, many children with OSA symptoms are not receiving a referral. It will be important to continue to study ways to identify children with OSA so that they can receive timely treatment.

Journal Articles

JOURNAL OF CLINICAL SLEEP MEDICINE

The Use of Computer Decision Support for Pediatric Obstructive Sleep Apnea Detection in Primary Care