Investigating socio-ecological factor in pediatrics sleep-related health Disparities

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Abstract Pediatric SDB, which ranges in severity from mild snoring to the most severe condition, obstructive sleep apnea syndrome (OSAS), is extremely common. SDB occurs in 10.5-17.1% of children, with 1-3% experiencing OSAS, making OSAS the second most common pediatric chronic health condition after asthma (8.6%). OSAS has been linked to considerable cardiometabolic, cognitive, and behavioral complications, including increased risk of death. Even mild SDB, or snoring without apnea, is associated with similar cardiometabolic and neurobehavioral impairments, such as hypertension, poor asthma control, and deficits in behavior, attention, and executive functioning. Untreated SDB can result in a 215% elevation in child healthcare usage and 40% more hospital visits. Many studies show that compared to White children, Black children are up to 6 times more likely to develop SDB across SDB severities. In the seminal Childhood Adenotonsillectomy Trial (CHAT), Black children had more severe OSAS on polysomnography (PSG) compared to children of other racial/ethnic backgrounds (p=0.004). This finding held even when controlling for factors that differ by race and contribute to OSAS severity, such as obesity. CHAT also found that Black children were less likely to improve following adenotonsillectomy (AT), the gold standard treatment for OSAS. In a prospective study conducted here at CHOP, 35% of Black children experienced post-operative respiratory complications following AT for OSAS compared to 24% in other races (p=.036). Finally, despite an increased prevalence of SDB in Black children, they are significantly less likely to receive AT treatment when diagnosed with OSAS compared to White children. Few studies have examined whether factors beyond comorbid conditions (obesity; prematurity; asthma) and variation in family socioeconomic status (SES) contribute to these observed disparities by race in SDB prevalence, sequelae, and treatment outcomes. Thus, the overall goal of this project is to identify novel socio-ecological factors contributing to disparities by race in SDB, particularly with regard to the SDB-related symptoms of sleepiness and neurobehavioral impairments, and to explore the role of provider's implicit racial bias in parent perceptions of SDB-related healthcare and disparities in referral patterns.