Socioeconomic Status Slows Treatment for Sleep-Disordered Breathing

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Among pediatric patients with sleep-disordered breathing, those with lower socioeconomic standing take longer to receive treatment compared with those with higher standing, according to a study published in JAMA Otolaryngology – Head & Neck Surgery.

More than half of children with sleep-disordered breathing failed to follow up for treatment at all, regardless of socioeconomic standing, reported Emily F. Boss, MD, MPH, of the John Hopkins School of Medicine in Baltimore, and colleagues.

Children with low socioeconomic status have an increased risk for sleep-disordered breathing, and the researchers sought to explore whether their socioeconomic status affected how long it took the patients to obtain polysomnography and surgical treatment with adenotonsillectomy.

The study included 136 children who were evaluated for sleep-disordered breathing over the course of 3 months. Of these children, 62 had public insurance, which the researchers used as an indicator of low socioeconomic status. Polysomnography was recommended for 55 children, 27 of whom fell into the low socioeconomic status group. After the initial visit, 24 of those 55 children never followed up (9 of the 24 had low socioeconomic status).

For children who did receive polysomnography, the mean interval between the initial appointment and treatment was longer for patients with low socioeconomic status compared with patients with higher socioeconomic standing (141.1 days vs. 49.9 days). For children who underwent adenotonsillectomy after undergoing polysomnography, the average time before undergoing surgery was longer for children with low socioeconomic status compared with those with higher standing (average 222.3 days vs. 95.2 days).

Almost half of patients who were referred to polysomnography did not follow up, regardless of socioeconomic standing, suggesting that polysomnography may be a deterrent for all children.

Child sleeping
Socioeconomic Status Slows Treatment for Sleep-Disordered Breathing

Although children with low socioeconomic status (SES) have increased risk for sleep-disordered breathing (SDB), their access to subspecialty care is often limited. Polysomnography (PSG) is the gold standard diagnostic test used to characterize SDB and diagnose obstructive sleep apnea; however, it is unknown whether SES impacts timeliness of obtaining PSG and surgical treatment with adenotonsillectomy (AT).

The purpose of this study was to evaluate the impact of soceoeconomic standing on the timing of polysomnogrophy, surgery with adenotonsillectomy, and loss to follow-up for children with sleep-disordered breathing.

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