Evidence-based Pediatric Obstructive Sleep Apnea Detection

Many children with obstructive sleep apnea (OSA) are not identified and thus do not receive treatment. In a previous study, the investigators found that a clinical decision support system helped primary care providers (PCPs) identify children with obstructive sleep apnea (OSA). In this system, parents of children report on possible OSA symptoms (e.g., snoring, sleepiness) in their child before the visit. If the child has OSA symptoms, the PCP receives an alert during the visit recommending further evaluation and a possible referral for a sleep study or to see a specialist. While this system helped increase the number of children with OSA symptoms who received a referral, many children remained unidentified. The goal of this study is to see whether involving parents in the system can identify even more children.

In this study, the investigators propose to test the impact of a health communication message, designed to educate and activate parents about their child's risk for OSA. This message is an infographic that helps parents recognize nighttime symptoms of OSA and how these nighttime symptoms may be impacting their child during the day. If a child has OSA symptoms, parents would view this infographic before their child's PCP visit and could discuss OSA with their child's PCP. For children with OSA symptoms, their parents will be randomized to either: 1) view the health communication message, or; 2) usual care, in which parents are not given any additional information about OSA or their child's risk prior to the appointment. In both cases, PCPs will receive a prompt indicating that the child is at risk for OSA.

• Health Communication Message (Behavioral): The health communication message is a single infographic developed iteratively with input from stakeholders (parents and providers). This image informs the parent that their child may have OSA, lists common nighttime symptoms parents may observe (e.g., snoring, apnea) and common daytime symptoms (e.g., hyperactivity, sleepiness) that can result from OSA. Parents are then encouraged to speak to their child's primary care provider if they observe these symptoms in their child.

Primary outcomes

• Rate of Completed OSA referral [Up to 12 months after study entry (date of positive OSA screen)]: Rate of children who received and completed (e.g., attended appointment or sleep study) a referral for sleep-disordered breathing, amongst those who screened positive for OSA. Referrals to include: 1) polysomnogram; 2) ENT referral; or 3) sleep medicine referral.

Secondary outcomes

• Rate of OSA referral [Up to 3 months after study entry (date of positive screen)]: Rate of children who received referral for sleep-disordered breathing, amongst whose who screened positive for OSA. Referrals to include: 1) polysomnogram; 2) ENT referral; or 3) sleep medicine referral.
• Rate of Evidence-based Evaluation [Up to 3 months after study entry (date of positive screen)]: Rate of child who received evidence-based evaluation for pediatric OSA, amongst those who screened positive for OSA. Evidence-based evaluation includes 1) OSA referral; 2) documented watchful waiting with follow-up plan; and/or 3) documentation of evaluation not consistent with sleep-disordered breathing.
• Rate of OSA Diagnosis [Up to 12 months after study entry (date of positive screen)]: Rate of children who received an OSA diagnosis (verified via polysomnogram; apnea hypopnea index >1.5), amongst those who screened positive for OSA.
• Rate of OSA Treatment [Up to 18 months after study entry (date of positive screen)]: Rate of children receiving OSA treatment, amongst those who screened positive for OSA. Treatment to include 1) surgical intervention; 2) CPAP; 3) dental device; and/or 4) medication.
• Rate of Parent Activation [Immediately after intervention (viewing the Health Communication Message)]: Rate of parents who report planning to speak with child's provider about OSA, amongst those who viewed the health communication message. This will be measured by parental response to an item asking if they plan to speak with their child's provider about OSA, presented at the time that the parent reviews the health communication message.

Sex: All, ages: 2 Years to 13 Years

Inclusion Criteria:

* Child ages 2.0-13.9 years at the time of OSA screening.
* Child is a primary care patient at Eskenazi Health
* Parent completed pre-visit questionnaire with OSA screening items
* Child screened positive for OSA (snoring >= 3 nights/wk + 1 additional symptom)

Exclusion Criteria:

* Prior OSA diagnosis
* Prior OSA referral (ENT, PSG, Sleep medicine) in the past two years

NIH grants: K23HL150299