Investigating socio-ecological factors in pediatric sleep-related health disparities

摘要 儿童SDB，其严重程度从轻微的鼾声到最严重的阻塞性睡眠呼吸暂停 综合症(OSAS)是一种非常常见的疾病。10.5%-17.1%的儿童发生SDB，1%-3%的儿童患有OSAS， 使OSAS成为仅次于哮喘的第二常见的儿童慢性健康疾病(8.6%)。OSAS一直是 与相当大的心脏代谢、认知和行为并发症有关，包括增加 死亡。即使是轻微的SDB，或者打呼而没有呼吸暂停，也与类似的心脏代谢和神经行为有关。 损害，如高血压、哮喘控制不良，以及行为、注意力和执行力缺陷 功能正常。未经治疗的SDB可导致儿童医疗保健使用量增加215%，医院增加40% 来访。许多研究表明，与白人儿童相比，黑人儿童患癌症的可能性高达6倍 跨SDB严重度的SDB。在生殖器儿童期扁桃体切除术试验(CHAT)中，黑人儿童有更多 重度阻塞性睡眠呼吸暂停综合征的多导睡眠图与其他种族/民族背景的儿童比较(p=0.004)。 即使在控制了不同种族并导致OSAS严重程度的因素时，这一发现也是成立的，例如 肥胖。Chat还发现，黑人儿童在接受腺扁桃体切除术(AT)后改善的可能性较小， 阻塞性睡眠呼吸暂停综合征的黄金标准治疗。在CHOP进行的一项前瞻性研究中，35%的黑人儿童 与其他种族的24%相比，阻塞性睡眠呼吸暂停综合征患者术后发生呼吸道并发症的比例为24% (P=.036)。最后，尽管黑人儿童中SDB的患病率增加，但他们患SDB的可能性要小得多 与白人儿童相比，被诊断为OSAS的儿童接受AT治疗。很少有研究检查过 家庭社会经济因素是否超出共病因素(肥胖、早产儿、哮喘)和变异 状态(SES)是导致SDB患病率、后遗症和治疗中种族差异的原因 结果。因此，该项目的总体目标是确定新的社会生态因素 在SDB中存在种族差异，特别是在与SDB相关的嗜睡症状和 神经行为障碍，并探索提供者的内隐种族偏见在父母中的作用 对与SDB相关的医疗保健的看法和转诊模式的差异。

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.