P3.D075: Awareness of Obstructive Sleep Apnea Screening Guidelines in Children with Down Syndrome Among Clinicians

Background: Down syndrome (DS) is one of the most prevalent inherited chromosomal disorders. Obstructive sleep apnea (OSA) is one of the most common comorbidities with an estimated prevalence of 50100% in children with DS. Untreated OSA in children with DS can lead to neurocognitive, cardiovascular, and metabolic dysfunction. The American Academy of Pediatrics (AAP) published clinical practice guidelines in 2011 recommending PSG screening for OSA in all children with DS by 4 years of age. In a recent retrospective study on children with DS, we noticed that nearly half of the children with DS are not screened for OSA before the recommended age of 4, promoting us to assess the screening awareness among primary care and pediatric subspecialty clinicians.

Methods: A 15-question qualitative survey was conducted to determine the current awareness of OSA screening in children with DS among clinicians in the state of Kentucky. The survey was sent to residents (pediatrics, medicine-pediatrics, family medicine, and ENT), outpatient general pediatricians, family medicine, and ENT clinicians in academic and non-academic practices in Kentucky. A Fisher's Exact test was performed to determine if the proportions of respondents differed significantly by provider type, level of training, and specialty.

Results: A total of 97 responses were included. Academic practice clinicians comprised 65%, group practices 26%, and private health care systems 6%. 75% of the clinicians specialized in pediatrics, 22% in family medicine, and 3% in ENT. Of the respondents, 50% were physician attendings, 27% were residents, and 23% were nurse practitioners or physician assistants. Although 94% of the respondents were aware that the prevalence of OSA in children with DS is higher than normally developing children, only 25% were aware of AAP guidelines and only 27% knew the age-specific threshold for screening regardless of symptoms. A significant difference existed between the type of clinicians who agreed that all DS children should undergo OSA screening regardless of symptoms: 85% (41/48) of physicians, 57% (15/26) of residents, and 81% (18/22) of nurse practitioners (p < 0.03). In term of specialty, 83% (56/67) in pediatrics, 50% (2/4) in medicine/pediatrics, and 59% (13/22) in family medicine (p < 0.003). There was variability in the reported estimated prevalence of OSA in children with DS among the 26 residents who agreed on screening regardless of symptoms, 3 (11%) responded >40%, 10 (38%) responded between 31-40%, 8 (30%) responded between 21-30%, and 5 (19%) responded between 10-20%.

Conclusion: AAP screening guidelines awareness for OSA in children with DS vary among clinicians, their practice, and their specialty in Kentucky. Given the clinical implications of OSA, clinicians can utilize this study to identify personal knowledge gaps and guide interventions to address the barriers to screening guidelines education.