PM2101: Health Disparities in Pediatric Obstructive Sleep Apnea

Background: Untreated obstructive sleep apnea (OSA) can negatively affect children’s health and behavior. Children who are Black, Hispanic, or from lower socioeconomic backgrounds tend to have higher rates of OSA and greater disease severity. Further, emerging work suggests these children may also be less likely to receive timely diagnosis and treatment. A polysomnogram (PSG) is used to diagnose OSA, but this process may be challenging for some families. Completing a PSG requires health literacy to navigate the referral system, resources to complete the study (e.g., time off work, transportation), as well as motivation to pursue diagnostic testing. The potential for income-related or racial/ethnic disparities in PSG completion and thus OSA detection has not yet been explored.

Methods: This study had two aims: 1) replicate previous research by examining racial/ethnic, and socioeconomic differences in OSA prevalence rates and disease severity; 2) extend prior work by examining whether there are racial, ethnic, and socioeconomic differences in timely OSA detection. OSA detection was assessed by examining PSG completion rates and age at time of PSG completion. We hypothesized that individuals from racial/ethnic minority backgrounds and those with fewer socioeconomic resources would be more likely to be diagnosed with OSA, experience more severe OSA, be less likely to complete PSG and would complete PSG at an older age.

Results: Electronic health records were examined for children (aged 1-18, N=1435, 58% male) referred for PSG. For those who successfully completed PSG, we recorded whether an OSA diagnosis was made as well as the Apnea Hypopnea Index (AHI), a measure of disease severity. Participant racial/ethnic background was as follows: White (73%), Black (24%), Asian (2%), or Biracial (1%); 9% of the sample was Hispanic. Socioeconomic status was assessed via maternal education: less than high school degree (7%), high school degree or GED (30%), some college (38%), or bachelor’s degree and beyond (25%).

Conclusion: Consistent with prior work, children from minority racial/ethnic and lower socioeconomic backgrounds were more likely to receive an OSA diagnosis (X2 = 9.01 and 8.25, respectively, p < 0.05). Children who were of minority racial backgrounds, Hispanic, or from lower socioeconomic backgrounds also tended to have higher AHI values (r = 0.09, -0.14, and -0.13, respectively, p < 0.05), suggesting greater disease severity. Extending prior work, we found that only 32.5% of those referred successfully completed PSG, with no differences across racial/ethnic, and socioeconomic backgrounds. There was a trend towards older age at PSG completion in children from minority race backgrounds (7.10 years vs. 5.90 years; r = 0.07, p = 0.10). This suggests a delay in diagnosis for these children, which could have costly implications for their health and academic performance and contribute to broader disparities.