96 - Evaluation for Obstructive Sleep Apnea among Children and Adolescents with Overweight and Obesity

Publication Number: 2091.96

Antony Lin, Georgetown University, Washington, DC, United States; Carlin F. Aloe, Yale School of Medicine, New Haven, CT, United States; Emily B. Finn, Yale School of Medicine, New Haven, CT, United States; Kaitlin Maciejewski, Yale University, New Haven, CT, United States; Jeremy Michel, Childrens Hospital of Philadelphia, Philadeelphia, PA, United States; Randall Grout, Indiana University School of Medicine, Indianapolis, IN, United States; Charles T. Wood, Duke University School of Medicine, Durham, NC, United States; Monica Ordway, Yale University School of Nursing, Southbury, CT, United States; Mona Sharifi, Yale School of Medicine, New Haven, CT, United States

Background: Pediatric obstructive sleep apnea (OSA) is more common among children with overweight/obesity with prior prevalence estimates ranging 13-59%. Yet, little is known about the prevalence and determinants of OSA evaluation among children with high body mass index (BMI) in primary care.

Objective: To describe prevalence of evaluation for OSA among children with overweight/obesity and to evaluate the extent to which patient and clinic-level characteristics are associated with evaluation.

Design/Methods: We queried electronic health records from children aged 2- < 19 years with BMI ≥85th percentile seen between 2023-2025 at 81 primary care practices affiliated with three health systems in the Northeast, Southeast and Midwest. We assessed prevalence of OSA evaluation defined as presence of OSA diagnosis, polysomnography order, or relevant specialist referral. We used multivariable logistic regression to assess associations between OSA evaluation and clinic setting, primary language, insurance, sex, race and ethnicity, age, and BMI category, adjusting for all other independent variables and health system as a covariate.

Results: Of 119,639 children, mean (SD) age was 10.3 (4.8) years; 49.1% were female; 14.0% had Spanish and 2.4% other primary language; 49.3% had obesity, 17.0% had severe obesity; and 22.5% had Hispanic/Latino and 33.6% non-Hispanic Black race-ethnicity. We found that 7,296 (6.1%) had evidence of OSA evaluation, ranging from 4.4% for youth with overweight, 7.9% for any obesity, to 16.9% for severe obesity (Table). We observed higher adjusted odds of OSA evaluation among children seen within academic vs. non-academic practices (aOR: 1.59 [95% CI: 1.50, 1.69]), Hispanic/Latino vs. non-Hispanic White race-ethnicity (1.16 [1.05, 1.27]), age 6-11 vs. 2-5 years (1.25 [1.17, 1.33]), or any class of obesity vs. overweight. We observed lower adjusted odds with Spanish (0.86 [0.78, 0.96]) or other (0.75 [0.62, 0.90]) vs. English language, private/commercial (0.88 [0.83, 0.93]) or other (0.56 [0.47, 0.67]) vs. public insurance, female sex (0.86 [0.82, 0.90]), other (0.86 [0.77, 0.96]) vs. non-Hispanic White race-ethnicity, or age 12-18 vs. 2-5 years (0.67 [0.62, 0.72]).

Conclusion(s): The prevalence of OSA evaluation in our sample was substantially lower than prior estimates of OSA prevalence in children with obesity (7.9% vs. 13-59%). Observed differences by clinic setting and patient characteristics may inform efforts to identify and address barriers to OSA evaluation among youth with overweight/obesity.

Prevalence and Adjusted Odds of Evidence of OSA Evaluation among Youth with Overweight/Obesity Stratified by Patient Characteristics (N = 119,639)