0744 Automated Universal OSA Screening in Pediatric Primary Care

Abstract Introduction Despite guidelines for evidence-based diagnosis of pediatric obstructive sleep apnea (OSA), studies have found low rates of OSA screening and referral in primary care. Guidelines recommend referral (e.g., polysomnogram, otolaryngology) for children with snoring and one additional OSA sign or symptom. Yet, specific screening strategies have not been identified and the prevalence of children who meet criteria for OSA referral has not been documented. The objectives of the current study are to: 1) describe a system to automate OSA screening; and 2) report the prevalence of children with snoring and at least one additional OSA sign or symptom. Methods We employed a computer decision support system (Child Health Improvement through Computer Automation; CHICA) to screen for snoring in all patients ages 2–11 years seen in two primary care clinics between February and December 2017. Parents of snoring children were also asked to report on symptoms of apnea, morning headache, sleepiness, trouble breathing at night, waking with a snort, and enuresis, with additional risk factors (overweight; ADHD diagnosis) pulled from the electronic health record. Clinics are located in Indianapolis, Indiana, and serve ethnically-diverse children from families with fewer socioeconomic resources (83.4% with Medicaid insurance). Results 1865 parents responded to a single item about snoring, resulting in the identification of 348 snoring children (18.5%). Amongst snoring children, OSA symptoms ranged from 6.0% for apnea to 45.0% for overweight. Overall, 77.9% of snoring children met criteria for referral with at least one additional OSA sign/symptom, representing 13.5% of all children screened. Conclusion Automated screening systems can be implemented to support PCPs in identifying children at-risk for OSA. As most snoring children in our sample met criteria for further evaluation, it will be important to further evaluate the appropriateness of the referral threshold as well as the readiness of the sleep medicine field to meet this need. Support (If Any) This project was made possible by an award from the American Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.