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

摘要 小儿睡眠呼吸暂停综合征，其严重程度从轻度打鼾到最严重的阻塞性睡眠呼吸暂停综合征 OSAS综合征（OSAS）是一种非常常见的疾病。SDB发生在10.5 - 17.1%的儿童中，其中1 - 3%患有OSAS， 使OSAS成为仅次于哮喘的第二大常见儿科慢性健康状况（8.6%）。OSAS已经 与相当多的心脏代谢、认知和行为并发症有关，包括增加 死亡即使是轻微的睡眠呼吸障碍，或打鼾无呼吸暂停，也与类似的心脏代谢和神经行为有关。 损伤，如高血压，哮喘控制不良，以及行为，注意力和执行力的缺陷 功能未经治疗的SDB可导致儿童医疗保健使用率上升215%，住院率上升40%。 探访许多研究表明，与白色儿童相比，黑人儿童的发育可能性高出6倍。 SDB跨SDB严重性。在开创性的儿童腺样体切除术试验（CHAT）中，黑人儿童的 与其他种族/民族背景的儿童相比，多导睡眠图（PSG）显示重度OSAS（p = 0.004）。 这一发现即使在控制了因种族而异并导致OSAS严重程度的因素时也是如此，例如 肥胖CHAT还发现，黑人儿童在扁桃体切除术（AT）后改善的可能性较小， 阻塞性睡眠呼吸暂停综合征的金标准治疗在CHOP进行的一项前瞻性研究中， 在AT治疗OSAS后发生了术后呼吸并发症，而其他种族为24% （p =.036）。最后，尽管SDB在黑人儿童中的患病率增加，但他们不太可能 与白色儿童相比，在诊断为OSAS时接受AT治疗。很少有研究探讨 是否有超出共病条件（肥胖、早产、哮喘）和家庭社会经济差异的因素 社会经济地位（SES）有助于观察到SDB患病率、后遗症和治疗的种族差异 结果。因此，本项目的总体目标是确定新的社会生态因素， SDB的种族差异，特别是在SDB相关的嗜睡症状方面， 神经行为障碍，并探讨供应商的隐性种族偏见在父母中的作用 对SDB相关医疗保健的看法以及转诊模式的差异。

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.