Evidence-based Detection of Pediatric Obstructive Sleep Apnea

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PROJECT SUMMARY / ABSTRACT Obstructive sleep apnea (OSA) affects an estimated 2.2 million US children. Despite guidelines for evidence- based diagnosis and management, many children continue to live with the negative consequences of untreated OSA. Studies suggest fewer than 25% of children with OSA symptoms receive appropriate evaluation and management. Children from racial and ethnic minority groups, as well as those with fewer economic resources, are even less likely to receive timely evidence-based diagnosis and care for pediatric OSA. Thus, there is a critical need for additional strategies to promote evidence-based detection of pediatric OSA. The overall objective of this research is to: (i) to develop a health communication message that actively engages parents by informing them of their child’s risk for OSA; and (ii) to determine its impact on OSA detection. The health communication message will be implemented as part of an existing computer decision support system for OSA (CHICA OSA), which includes automated OSA screening and prompts to primary care providers (PCPs). Specific aims are as follows: SPECIFIC AIM 1: Develop and iteratively refine a health communication message for parents of children with a positive OSA screen. Stakeholders (e.g., parents, PCPs, sleep medicine specialists) will be engaged in the creation and iterative refinement of the message. Parent stakeholders will represent the populations served in our clinics, primarily black, white Hispanic, and white Non-Hispanic families with Medicaid insurance. This message will be delivered to parents of children with a positive OSA screen prior to meeting with the PCP, with the goal of encouraging parents to: (i) discuss OSA with the PCP; and (ii) attend referral appointments. SPECIFIC AIM 2: Evaluate the impact of the health communication message on OSA detection. Parents of children who screen positive for OSA within CHICA OSA will be randomized to receive the health communication message or no additional information (control). We hypothesize that parents randomized to the message will be more likely to complete an OSA referral appointment (primary outcome). This study will identify strategies to improve detection of pediatric OSA, with a focus on populations underrepresented in healthcare research with the lowest detection rates. The applicant’s career goal is to become an expert and leader in the development and evaluation of strategies that promote evidence-based identification and management of pediatric sleep disorders in primary care, with a focus on computer decision support (informatics). This NHLBI K23 award includes additional training in the following areas: (i) dissemination and implementation research. and (ii) health informatics. Training and research activities will be conducted at the Indiana University School of Medicine.