Factors Associated With Screening Disparities for Pediatric Sleep-Disordered Breathing

Introduction: Black children disproportionately experience obstructive sleep-disordered breathing (SDB) and persistent disparities in access to treatment. The American Academy of Pediatrics guidelines recommend that all children should undergo screening for snoring and appropriate specialist evaluation. Disparities in screening have not been well studied.

Methods: This was a retrospective chart review of children ages 2 to < 12 years presenting for well-child visits within our hospital’s network in August 2022. Demographics and SDB screening status were extracted. We excluded children who were previously diagnosed with SDB or were established with otolaryngology. Univariable and multivariable logistic regression were used to identify covariates related to screening for SDB.

Results: A total of 461 children were included with a documented screening rate of 45.1% for snoring (median age 5 IQR [3-8] years, 47.7% male). Over half of White 53% (71/134), 45.1% (64/142) of Other, and 39.5% (73/185) of Black children were screened. A total of 40 (8.7%) patients screened positive for snoring, of which 60% (24/40) did not undergo further intervention, 30% (12/40) received intranasal steroids, and 10% (4/40) were referred to a specialist (otolaryngology or sleep medicine). None were recommended a polysomnography. Multivariable logistic regression revealed that when controlling for age and sex, the odds of being screened for SDB were 0.4 times lower for Black children than their White counterparts (OR 0.6, 95%CI [0.4-0.9], p=0.02). However, when controlling for other factors, such as the involvement of a trainee, clinic location, use of a template, racial differences in documented screening were no longer significant (OR 0.9, [0.5-1.4], p=0.6). In the same model, the odds of being screened for snoring was 4 times higher if a template was used (OR 4 [1.8-8.6]; p< 0.001).

Conclusions: In this cohort, the overall SDB screening rate was low, with less than half of children screened. The results suggest that while racial disparities were found for Black children, this may be mediated by factors such as trainee involvement or note template use.