Screening for sleep disorders in pediatric primary care: are we there yet?

Objectives: Obstructive sleep apnea (OSA) and habitual snoring are highly prevalent childhood conditions and have been associated with a large array of negative health outcomes. Although guidelines were published by the American Academy of Pediatrics (AAP) a decade ago recommending routine screening of sleep-disordered breathing (SDB) in primary care settings, it remains unclear to what extent such guidelines have been implemented and resulted in effective SDB screening. The aim of this study was to determine if AAP guidelines are adhered to in pediatric primary care.

Study Design: In all, 1032 electronic charts of children 4 to 17 years old presenting for well-child visits to 17 pediatricians between January 1 and December 31, 2010, were manually reviewed. Abstracted data included demographic variables and documentation of snoring as well as other sleep-related complaints.

Results: The mean age was 8.5 ± 3.9 years (mean ± standard deviation), 49.9% were male, and 79.7% were Hispanic; 24.4% (n = 252) were screened for snoring. Of the children screened for sleep-related issues, 34.1% (n = 86) snored, but the majority of them (61.6%, n = 53) received no further evaluation. In the present sample, 0.5% (n = 5) had a diagnosis of OSA.

Conclusions: The low prevalence of OSA may be explained by the relatively low frequency of sleep-related problem screening by pediatricians and thus the inordinately low adherence to the AAP guidelines. Modification and transition to electronic medical records as well as expanded efforts to educate health care providers and caregivers may improve detection and timely treatment of children at risk for SDB.