Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
J Clin Sleep Med. 2019 Mar 15;15(3):453-462. doi: 10.5664/jcsm.7674.
To (1) describe outcomes from a computer decision support system (CDSS) for pediatric obstructive sleep apnea (OSA) detection in primary care; and (2) identity the prevalence of children meeting criteria for an OSA referral.
A CDSS for OSA was implemented in two urban primary care clinics. Parents of children (age 2 to 11 years) presenting to the clinic were asked if their child snored regularly, with a positive response resulting in six additional OSA screening items. Primary care providers (PCPs) received a prompt for all snoring children, listing applicable OSA signs and symptoms and recommending further evaluation and referral for OSA.
A total of 2,535 children were screened for snoring, identifying 475 snoring children (18.7%). Among snoring children, PCPs referred 40 (15.4%) for further evaluation. The prevalence of additional OSA signs and symptoms ranged from 3.5% for underweight to 43.7% for overweight. A total of 74.7% of snoring children had at least one additional sign or symptom and thus met American Academy of Pediatrics guidelines criteria for an OSA referral.
A CDSS can be used to support PCPs in identifying children at risk for OSA. Most snoring children met criteria for further evaluation. It will be important to further evaluate this referral threshold as well as the readiness of the sleep medicine field to meet this need.
Registry: ClinicalTrials.gov, Title: Evidence-based Diagnosis and Management of Pediatric Obstructive Sleep Apnea in Primary Care, Identifier: NCT02781376, URL: https://clinicaltrials.gov/ct2/show/NCT02781376.
（1）描述初级保健中用于小儿阻塞性睡眠呼吸暂停（OSA）检测的计算机决策支持系统（CDSS）的结果；（2）确定符合 OSA 转诊标准的儿童的患病率。
在两家城市初级保健诊所实施了 OSA 的 CDSS。向到诊所就诊的儿童（2 至 11 岁）的父母询问其子女是否经常打鼾，如果回答是，则进行另外六个 OSA 筛查项目。初级保健提供者（PCP）会收到所有打鼾儿童的提示，列出适用的 OSA 体征和症状，并建议进一步评估和转诊进行 OSA 检查。
共有 2535 名儿童接受了打鼾筛查，发现 475 名打鼾儿童（18.7%）。在打鼾儿童中，PCP 转介了 40 名（15.4%）进行进一步评估。其他 OSA 体征和症状的患病率从体重不足的 3.5%到超重的 43.7%不等。共有 74.7%的打鼾儿童至少有一个额外的体征或症状，因此符合美国儿科学会的 OSA 转诊标准。
CDSS 可用于支持 PCP 识别患有 OSA 风险的儿童。大多数打鼾儿童符合进一步评估的标准。评估这一转诊阈值以及睡眠医学领域是否准备好满足这一需求将非常重要。
注册处：ClinicalTrials.gov，标题：初级保健中儿童阻塞性睡眠呼吸暂停的循证诊断和管理，标识符：NCT02781376，网址：https://clinicaltrials.gov/ct2/show/NCT02781376。
