ATS 2017, WASHINGTON, DC -- Pediatric severe obstructive sleep apnea (OSA) in the Washington, DC metropolitan area is most common among inner city African-American children from low income families, according to a new study presented at the 2017 American Thoracic Society International Conference. The researchers also found that these children were most likely to have a delayed diagnosis.
"Earlier studies have shown that OSA is more prevalent among inner city children," said lead author Sasikumar Kilaikode Cheruveettara, MD, from Children's National Health System, Washington, DC. "We wanted to see if this was the case in Washington, DC, as we have a large inner city minority population. We also wanted to address the lack of data on the characteristics of severe OSA in inner city children and adolescents."
OSA, which interferes with one's ability to function, and can cause other serious health consequences, is a surprisingly common pediatric condition, affecting 3 percent of American children.
Dr. Kilaikode Cheruveettara and colleagues looked retrospectively at the medical records of 150* severe OSA patients who were seen in the health system's Pediatric Sleep Center. Severe OSA was defined as having 10 or more events per hour in which the patient stops breathing, as measured in an initial sleep study. Among these patients, the researchers looked at demographic variables, including where they live, their race/ethnicity and their socioeconomic status.
The vast majority of severe OSA patients were identified as being African American. African-American children had a two-year median duration of symptoms before being diagnosed - double that of white children. The regions with the most severe cases of OSA were also those with the largest proportion of low income and minority children: Prince George County, Maryland, and neighborhoods of Washington, DC that have the highest poverty levels.
"We have demonstrated that there is a critical need to focus care, resources and education to identify and treat pediatric OSA in minority communities of inner city areas," said Dr. Kilaikode Cheruveettara. "These children may be at the highest risk for severe OSA due to premature birth, and a high prevalence of asthma and allergies. Lack of awareness at the family level delays reporting of symptoms and ultimately leads to delayed diagnosis."
He added: "Our future directions include identifying barriers to timely diagnosis and early referral. We envision area-focused education and awareness for observing and reporting symptoms of OSA in children. Our future plans also include providing awareness at the primary health provider level and reinforcing mandatory screening for symptoms of OSA during well child visits. In addition, we plan to develop school and community based education initiatives."
* Data analysis is being done with an additional 100 patients.
Contact for study: Sasikumar Kilaikode Cheruveettara, MD, SCheruve@childrensnational.org
Distinguishing Characteristics of Severe Obstructive Sleep Apnea in Inner-City Children and Adolescents
Type: Scientific Abstract
Topic: 31. Sleep Disordered Breathing / Pediatric / Diagnosis / Pediatrics (PEDS)
Authors: S. Kilaikode, M. Weiss, R. Megalaa, P. Kovacs, R. Koothirezhi, L. Mukharesh, S. Wolf, D. Lewin, G. Perez, G.R. Nino; Children's National Health System - Washington, DC/US
Introduction: Obstructive sleep apnea (OSA) is a very common condition affecting 3% of the pediatric population in the United States. Importantly, OSA is disproportionally more prevalent among children with disadvantaged backgrounds (racial/ethnic minorities). OSA severity also appears to be greater in minority groups. However, there is lack of data describing the characteristics of severe OSA in inner-city minority children and adolescents. To address this gap we examined the clinical, polysomnographic and socioeconomic features of severe pediatric OSA in Washington D.C, an area with one of the highest prevalence of inner city minority children in the country. Specifically, we hypothesized that inner city minority children will have higher prevalence of severe OSA and will be more likely to have a delayed severe OSA diagnosis (>1 year after the onset of symptoms).
Methods: Retrospective review was done including cases of severe OSA followed in our Pediatric Sleep Center. Severe OSA was defined as an obstructive apnea hypopnea index (OAHI) of more than 10 events per hour based on initial overnight polysomonogram (PSG). We used electronic medical record review PSG variables to characterize individuals with severe OSA and stratified results based on racial/ethnic background as well as geographic/socioeconomic status.
Results: 150 eligible children (mean age 7 years, ±SD 5.3) were enrolled during the study period (Sept 2015-2016). We identified that the vast majority of children in our inner city cohort were African American (AA)/Black (n=91, 61%). Importantly, AA/black children had a median duration of symptoms prior to diagnosis of 24 months (IQR 12-43 months), which was double of that in Caucasian/White. Moreover, severe hypoxemia due to OSA (SaO2 nadir <75%) was significantly more common in AA/black (n=39, 64%) than in other ethnic groups. We also observed that the county with the largest proportion of minorities and low income families in D.C. metropolitan area accounted for most severe OSA cases (Prince George county, MD, 44%). In addition, we observed the highest prevalence of severe OSA in DC wards with the highest poverty levels (Figure 1).
Conclusion: Inner city AA/black children had the highest prevalence of severe OSA and were more likely to have a delayed diagnosis. Geographical distribution of severe OSA corresponded to low economic status. Our study indicates that there is a critical need to focus care, resources and education to identify and treat pediatric OSA in minority communities of inner city areas.
FOR MORE INFORMATION, CONTACT:
ATS Office 212-315-8620 (until May 17)
PRESS CONFERENCE: Monday, May 22, 2017, 4:45 p.m.; Room 148 (Middle Building, Street Level) Walter E. Washington Convention Center
Session: D16 Can Children Sleep and Breathe at the Same Time?
Abstract Presentation Time: Wednesday, May 24, 10:15 a.m. ET
Location: Room 202 A (South Building, Level 2), Walter E. Washington Convention Center