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Landeo-Gutierrez J, Ryu J, Tantisira K, Bhattacharjee R. Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California. J Clin Sleep Med 2024; 20:1637-1645. [PMID: 38913342 PMCID: PMC11446114 DOI: 10.5664/jcsm.11238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
STUDY OBJECTIVES Pediatric obstructive sleep apnea (OSA) is common; however, inclusion of adolescents and especially those of ethnic/racial minorities in research is scarce. We hypothesized that ethnic/racial minority adolescents undergoing polysomnography have higher prevalence and more severe OSA compared to those who are non-Hispanic (NH) White. METHODS Retrospective review of 1,745 adolescents undergoing diagnostic polysomnography. Demographic characteristics, age, body mass index percentile, and polysomnography parameters were obtained. Descriptive statistics comparing race/ethnicity were analyzed. Linear regression of log-transformed obstructive apnea-hypopnea index, and logistic regression of moderate-severe OSA (obstructive apnea-hypopnea index ≥ 5 events/h) adjusting for covariates were analyzed. RESULTS A total of 58.2% adolescents were Hispanic, 24.1% NH-White, 4.3% NH-Asian/Pacific Islander, 4.2% NH-Black/African American, and 6.6% NH-other. Compared to the NH-White group, the Hispanic group had higher obstructive apnea-hypopnea index and any level of OSA severity, the Black/African American group had higher any level of OSA, and the NH-Asian group had higher moderate-severe OSA. Multiple linear regression of log-obstructive apnea-hypopnea index identified a positive association with Hispanic ethnicity (β: 0.25, P value < .05). Compared to the NH-White group, the Hispanic and the Asian/Pacific Islander groups were 1.45 (95% confidence interval: 1.10, 1.93) and 1.81 (95% confidence interval: 1.05, 3.10) times more likely to have moderate-severe OSA, respectively, after adjusting for relevant covariates. Stratified analysis by sex identified an association only among males between Hispanic ethnicity (odds ratio: 1.85, 95% confidence interval: 1.27, 2.70) and Asian/Pacific Islander ethnicity (odds ratio: 2.62, 95% confidence interval: 1.35, 5.11) and moderate-severe OSA, compared to the NH-White group. CONCLUSIONS Among adolescents undergoing polysomnography evaluation, we identified OSA racial/ethnic and sex disparities in Hispanic and NH-Asian adolescents. Community level studies with adequate representation of these minority groups are needed to identify factors associated with the reported increased susceptibility. CITATION Landeo-Gutierrez J, Ryu J, Tantisira K, Bhattacharjee R. Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California. J Clin Sleep Med. 2024;20(10):1637-1645.
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Affiliation(s)
- Jeremy Landeo-Gutierrez
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
| | - Julie Ryu
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
| | - Kelan Tantisira
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
| | - Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
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Te TT, Phan TT. Racial and ethnic disparities in pediatric obstructive sleep apnea: insights from a large study on adolescents in southern California. J Clin Sleep Med 2024; 20:1567-1568. [PMID: 39132683 PMCID: PMC11446116 DOI: 10.5664/jcsm.11306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Tue T. Te
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
- Geriatric, Research, Education and Clinical Center, VA Greater Los Angeles, Los Angeles, California
| | - Thea T. Phan
- Portola Highly Gifted Magnet, Los Angeles, California
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Kim J, Nwaogu C, Mitchell RB, Johnson RF. Influence of Economic Connectedness on Pediatric Obstructive Sleep Apnea Severity and Adenotonsillectomy Outcomes. Otolaryngol Head Neck Surg 2024; 171:1181-1189. [PMID: 38881394 DOI: 10.1002/ohn.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine the influence of economic connectedness (EC), a measure of social capital, on obstructive sleep apnea (OSA) severity and adenotonsillectomy outcomes in children. STUDY DESIGN Retrospective study. SETTING Single tertiary medical center. METHODS The study population included 286 children who were referred for full-night polysomnography for OSA and underwent adenotonsillectomy. The primary outcome was the relationship between EC and the presence of severe OSA, and secondary outcomes included postoperative emergency room visits and residual OSA after adenotonsillectomy. Linear regression, Kruskal-Wallis test, Pearson's χ2 test, and multiple logistic regression were used for categorical and continuous data as appropriate. RESULTS In this population, the median age was 9.0 (interquartile range [IQR] = 6.9-11.7) and 144 (50.3%) were male. The majority were white (176, 62.0%), black (60, 21.1%), and/or of Hispanic ethnicity (173, 60.9%). The median EC of this population was 0.64 (IQR = 0.53-0.86). Higher EC was associated with decreased odds of having severe OSA (odds ratio: 0.17, 95% confidence interval = 0.05-0.61). However, EC was not associated with either postoperative emergency room visits or residual OSA. CONCLUSION EC was significantly associated with severe OSA (ie, apnea-hypopnea index ≥ 10) but not with postoperative emergency room visits or residual OSA after adenotonsillectomy. Further research is needed to understand the effects of various social capital measures on pediatric OSA and adenotonsillectomy outcomes.
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Affiliation(s)
- Jenny Kim
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cullins Nwaogu
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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Chacon MA, Cook CA, Flynn-O'Brien K, Zagory JA, Choi PM, Wilson NA. Assessing the Impact of Neighborhood and Built Environment on Pediatric Perioperative Care: A Systematic Review of the Literature. J Pediatr Surg 2024; 59:1378-1387. [PMID: 38631997 PMCID: PMC11164636 DOI: 10.1016/j.jpedsurg.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Abstract
CONTEXT Neighborhood and built environment encompass one key area of the Social Determinants of Health (SDOH) and is frequently assessed using area-level indices. OBJECTIVE We sought to systematically review the pediatric surgery literature for use of commonly applied area-level indices and to compare their utility for prediction of outcomes. DATA SOURCES A literature search was conducted using PubMed, Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print, PsycInfo, and an artificial intelligence search tool (1/2013-2/2023). STUDY SELECTION Inclusion required pediatric surgical patients in the US, surgical intervention performed, and use of an area-level metric. DATA EXTRACTION Extraction domains included study, patient, and procedure characteristics. RESULTS Area Deprivation Index is the most consistent and commonly accepted index. It is also the most granular, as it uses Census Block Groups. Child Opportunity Index is less granular (Census Tract), but incorporates pediatric-specific predictors of risk. Results with Social Vulnerability Index, Neighborhood Deprivation Index, and Neighborhood Socioeconomic Status were less consistent. LIMITATIONS All studies were retrospective and quality varied from good to fair. CONCLUSIONS While each index has strengths and limitations, standardization on ideal metric(s) for the pediatric surgical population will help build the inferential power needed to move from understanding the role of SDOH to building meaningful interventions towards equity in care. TYPE OF STUDY Systematic Review. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Miranda A Chacon
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA
| | - Caitlin A Cook
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA
| | - Katherine Flynn-O'Brien
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 8915 W. Connell Ct., Milwaukee, WI 53226, USA
| | - Jessica A Zagory
- Division of Pediatric Surgery, Department of Surgery, Louisiana State University Health Sciences Center - New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Pamela M Choi
- Department of Surgery, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Nicole A Wilson
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA; Department of Biomedical Engineering, University of Rochester, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA.
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Danis DO, Palmer WJ, Bachrach K, Tracy LF, Levi JR. Racial Disparity in Tympanostomy Tube Placement in Inpatient Pediatric Admissions. Clin Pediatr (Phila) 2023; 62:1531-1536. [PMID: 37060287 DOI: 10.1177/00099228231167685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
This study aims to evaluate if race and ethnicity affect rates of tympanostomy tube (TT) placement during inpatient pediatric admissions in children with otologic conditions. A review of the 2016 Kids' Inpatient Database was conducted based on the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for common otologic conditions. Among 85 827 weighted pediatric inpatient discharges with ICD-10-CM codes for common otologic conditions, 213 underwent TT placement. Odds ratios (ORs) for children of Hispanic ethnicity and Asian or Pacific Islander race undergoing TT placement when compared to other ethnicities and races were 0.60 (P = .011) and 0.21 (P = .040), respectively. Multiple logistic regression showed Hispanic ethnicity was associated with lower rates of TT placement when compared to non-Hispanic white children (OR = 0.62; 95% confidence interval = 0.40-0.96). Future studies should assess why these differences exist and if these differences are associated with racial/ethnic bias or attributed to patient/family preference.
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Affiliation(s)
- David O'Neil Danis
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Kevin Bachrach
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Lauren F Tracy
- School of Medicine, Boston University, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- School of Medicine, Boston University, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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Luong S, Culp M, McCreary M, Wani A, Caraballo M. Reasons and predictors for early termination of pediatric polysomnography: one children's hospital's experience. J Clin Sleep Med 2023; 19:1711-1716. [PMID: 37143378 PMCID: PMC10546001 DOI: 10.5664/jcsm.10646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/06/2023]
Abstract
STUDY OBJECTIVES We sought to identify reasons for early polysomnography termination in pediatric patients. METHODS We retrospectively reviewed all studies conducted at the Pediatric Sleep Center at UT Southwestern Medical Center from January 1, 2017, through December 31, 2019, that were terminated before study completion. We investigated reasons for early termination and gathered characteristics such as age, sex, presence of neurocognitive impairment, payor status, seasonal variability, and testing site location. RESULTS There were 137 patients who terminated their studies before completion, comprising 1.05% of all patients who arrived for their scheduled polysomnographies during that time frame. The 3 main categories of reasons were equipment intolerance (47%), acute illness (33%), and parental refusal (20%). Parental refusal reasons included the patient's becoming combative, a lack of specialized equipment, patient's inability to fall asleep, forgetting the patient's nighttime medications, and the parent's inability to stay the night. Males represented a greater proportion of those who terminated due to intolerance of equipment (75%). Patients who terminated early due to equipment intolerance consisted of more neurologically impaired patients compared with those who terminated due to acute illness (56% vs 24%). Termination due to acute illness occurred more during the wintertime (44%) than in the summer (7%). In those who terminated due to parental refusal, there was a greater proportion of children under 6 years of age (75%). CONCLUSIONS Determining factors that are associated with early polysomnography termination is an important step to help identify at-risk groups and implement strategies to improve study completion. CITATION Luong S, Culp M, McCreary M, Wani A, Caraballo M. Reasons and predictors for early termination of pediatric polysomnography: one children's hospital's experience. J Clin Sleep Med. 2023;19(10):1711-1716.
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Affiliation(s)
- Shan Luong
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Marilyn Culp
- Sleep Medicine, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Morgan McCreary
- Department of Neurology, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Anna Wani
- Department of Family and Community Medicine and Department of Pediatrics, Division of Pediatric Sleep Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Michelle Caraballo
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
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Kim J, Kou Y, Chorney SR, Mitchell RB, Johnson RF. Assessment of neighborhood-level disadvantage and pediatric obstructive sleep apnea severity. Laryngoscope Investig Otolaryngol 2023; 8:1114-1123. [PMID: 37621268 PMCID: PMC10446263 DOI: 10.1002/lio2.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/08/2023] [Accepted: 06/09/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives To examine the relationship between neighborhood-level advantage and severe obstructive sleep apnea (OSA) in children. Methods A retrospective case-control study was conducted on 249 children who underwent adenotonsillectomy and had full-night polysomnography conducted within 6 months prior. Patients were divided into more or less socioeconomically disadvantaged groups using a validated measure, the area deprivation index (ADI). The primary outcomes were the relationship between the apnea-hypopnea index (AHI) and the presence of severe OSA, and the secondary outcome was residual moderate or greater OSA after tonsillectomy. Results Of the 249 children included in the study, 175 (70.3%) were socially disadvantaged (ADI > 50). The median (interquartile range [IQR]) age was 9.4 (7.3-12.3) years, 129 (51.8%) were male, and the majority were White (151, 60.9%), Black (51, 20.6%), and/or of Hispanic (155, 62.5%) ethnicity. A total of 140 (56.2%) children were obese. The median (IQR) AHI was 8.9 (3.9-20.2). There was no significant difference in the median AHI or the presence of severe OSA between the more and less disadvantaged groups. Severe OSA was found to be associated with obesity (odds ratio [OR] = 3.13, 95% confidence interval [CI] = 1.83-5.34), and residual moderate or greater OSA was associated with older age (OR = 1.20, 95% CI = 1.05-1.38). Conclusions The ADI was not significantly associated with severe OSA or residual OSA in this cohort of children. Although more neighborhood-level disadvantage may increase the risk of comorbidities associated with OSA, it was not an independent risk factor in this study. Level of Evidence Level 4.
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Affiliation(s)
- Jenny Kim
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Yann‐Fuu Kou
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Stephen R. Chorney
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Ron B. Mitchell
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Romaine F. Johnson
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
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Sommerfeldt J, Duffy A, Blanco C, Kolb CM, Freeman C, Aaronson NL. Factors affecting polysomnography compliance and delays to surgical treatment of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2023; 171:111637. [PMID: 37348250 DOI: 10.1016/j.ijporl.2023.111637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To evaluate adherence to polysomnography in pediatric patients and determine if demographics, socioeconomic status, polysomnography indication, or prior otolaryngology intervention are associated with polysomnography adherence and time to definitive surgery. STUDY DESIGN Retrospective review study. SETTING Tertiary-care children's hospital. METHODS Electronic medical record was queried to identify patients ordered for a sleep study between January and May 2019. Demographic information, time to sleep study, and time to surgery were collected and calculated. RESULTS 304 patients were recommended to obtain polysomnography, with adherence rate of 65.4%. There was no significant difference in adherence or loss to follow-up rates based on patient sex, age, language, socioeconomic status, state of residence, single-parent status, or polysomnography indication. There was no difference between time to surgery for patients who did or did not obtain polysomnography (181 vs. 161 days, P = .51). Patients with prior otolaryngology intervention were more likely to obtain polysomnography and less likely to be lost to follow-up (P < .05). Median household income demonstrated a significant inverse relationship with time to polysomnography (P < .05) as well as time to surgery (P < .05). Medically complex patients tended to experience longer time to surgery compared with non-complex patients. CONCLUSION Families with lower socioeconomic status or medically complex children may require assistance to obtain polysomnography and pursue surgery for sleep-disordered breathing. Patients without prior otolaryngology intervention may be less likely to follow up and may need assistance with navigating the polysomnography process.
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Affiliation(s)
- John Sommerfeldt
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, 96859, USA
| | - Alexander Duffy
- Department of Otolaryngology - Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | | | - Caroline M Kolb
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, 96859, USA
| | | | - Nicole L Aaronson
- Division of Pediatric Otolaryngology, Nemours Children's Health, Wilmington, DE, 19803, USA; Department of Otolaryngology - Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
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Johnson DA, Ohanele C, Alcántara C, Jackson CL. The Need for Social and Environmental Determinants of Health Research to Understand and Intervene on Racial/Ethnic Disparities in Obstructive Sleep Apnea. Clin Chest Med 2022; 43:199-216. [PMID: 35659019 DOI: 10.1016/j.ccm.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Obstructive sleep apnea (OSA), a sleep-disordered breathing (SDB) disorder, affects at least 25 million adults in the United States and is associated with increased risk for hypertension, diabetes, and cardiovascular disease (CVD). Racial/ethnic minorities have a disproportionate burden of OSA along with the health sequelae associated with this condition. Despite supporting evidence of racial/ethnic disparities, few studies have investigated SDB including OSA among minoritized racial/ethnic groups. In this scoping review of the literature, the authors summarize current findings related to racial/ethnic disparities in OSA, identified social and environmental determinants of health, treatment inequities, and promising evidence-based interventions and conclude with future research directions.
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Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 3025, Atlanta, GA 30322, USA.
| | - Chidinma Ohanele
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 3025, Atlanta, GA 30322, USA
| | - Carmela Alcántara
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, Room 917, New York, NY 10027, USA
| | - Chandra L Jackson
- Epidemiology Branch, Social and Environmental Determinants of Health Equity, National Institute of Environmental Health Sciences, National Institutes of Health, 111 T.W. Alexander Drive, Room A327, Research Triangle Park, 27709 Post: P.O. Box 12233, Mail Drop A3-05, NC 27709, USA; Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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Park JW, Hamoda MM, Almeida FR, Wang Z, Wensley D, Alalola B, Alsaloum M, Tanaka Y, Huynh NT, Conklin AI. Socioeconomic inequalities in pediatric obstructive sleep apnea. J Clin Sleep Med 2022; 18:637-645. [PMID: 34170224 PMCID: PMC8805007 DOI: 10.5664/jcsm.9494] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To examine the association between multiple measures of socioeconomic status (SES) and objectively measured obstructive sleep apnea (OSA) in a Canadian pediatric population. METHODS This was a cross-sectional study of 188 children (4-17 years, mean age 9.3 ± 3.5 years) prospectively recruited from two hospital sleep clinics in Canada, using multivariable-adjusted linear and logistic regression of five measures of SES including parental education, income, social class, geographic location, and perceived SES based on the MacArthur Scale of Subjective Social Status, assessed in relation to four polysomnographic OSA variables including apnea-hypopnea index, apnea index, mean oxygen saturation level, and oxygen desaturation index. RESULTS Overall, low household-level SES appeared to be associated with both frequency (apnea index ≥ 1 events/h) and severity (apnea-hypopnea index ≥ 5 events/h) of OSA in children, with maternal education showing the most consistent and significant associations. Specifically, children with mothers reporting less than high school education had nearly three times the odds of having OSA after controlling factors including body mass index (odds ratio 2.96 [95% confidence interval, 1.05-8.37]), compared to university-educated participants. Consistent associations were also observed for geographic location with less frequency and severity of OSA among nonurban children. Perceived SES was minimally inversely associated with our outcomes. CONCLUSIONS This cross-sectional, multicenter study demonstrated that SES factors are linked to the occurrence and severity of OSA in children. Results indicated the need to incorporate the screening of SES in the diagnostic process of pediatric OSA to provide more targeted intervention and patient-centered care. CITATION Park JW, Hamoda MM, Almeida FR, et al. Socioeconomic inequalities in pediatric obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):637-645.
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Affiliation(s)
- Ji Woon Park
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada,Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Mona M. Hamoda
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fernanda R. Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada,Address correspondence to: Fernanda R. Almeida, DDS, PhD, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada; Tel: +1-604-822-3623;
| | - Zitong Wang
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada,Department of Biostatistics, School of Global Public Health, New York University, New York, New York
| | - David Wensley
- Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam Alalola
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada,Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alsaloum
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia,Department of Restorative and Prosthetic Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yasue Tanaka
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada,Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Nelly T. Huynh
- Faculty of Dental Medicine, Université de Montréal, Montreal, Quebec, Canada,Centre de Recherche, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annalijn I. Conklin
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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11
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Mayne SL, Mitchell JA, Virudachalam S, Fiks AG, Williamson AA. Neighborhood environments and sleep among children and adolescents: A systematic review. Sleep Med Rev 2021; 57:101465. [PMID: 33827031 PMCID: PMC8164975 DOI: 10.1016/j.smrv.2021.101465] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/04/2021] [Accepted: 02/26/2021] [Indexed: 01/31/2023]
Abstract
Understanding salient environmental determinants of pediatric sleep is essential for informing interventions and public health initiatives. Emerging evidence suggests that the neighborhood environment can impact pediatric sleep, but this evidence has not yet been systematically reviewed. We conducted a systematic review of the scientific literature on associations between neighborhood environments and sleep in young children (0-5 y), school-aged children (6-12 y) and adolescents (13-18 y). We reviewed 85 articles published between 2003 and 2020. The most commonly examined neighborhood exposure was low socioeconomic status (40 studies), which was associated with sleep outcomes in 58% of studies (primarily shorter sleep duration, later sleep timing, or obstructive sleep apnea). Evidence was stronger for neighborhood safety/crime/violence (21 studies), with 86% of studies reporting associations with sleep outcomes (primarily self- or caregiver-reported sleep problems). Fewer studies examined associations of neighborhood physical environment exposures, including noise (15 studies), the built environment (seven studies), and air pollution (six studies). Limitations of the current body of evidence include 1) limited examination of neighborhood exposures other than socioeconomic status or safety, 2) use of primarily cross-sectional observational study designs, 3) lack of objective sleep outcome assessment, and 4) limits of current exposure assessment methods.
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Affiliation(s)
- Stephanie L Mayne
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Jonathan A Mitchell
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Alexander G Fiks
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Ariel A Williamson
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Sleep Center, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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12
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Barengo JH, Redmann AJ, Kennedy P, Rutter MJ, Smith MM. Demographic Characteristics of Children Diagnosed with Bacterial Tracheitis. Ann Otol Rhinol Laryngol 2021; 130:1378-1382. [PMID: 33834902 DOI: 10.1177/00034894211007250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Examine the presentation and clinical course of patients with bacterial tracheitis (BT). Identify if socioeconomic differences exist among children who present with BT. METHODS This was a retrospective case series from a tertiary care pediatric medical center. The study group included patients less than 18 years old who were diagnosed with BT from January 2011 to March 2019. Patients with a tracheostomy and those who developed BT after prolonged hospitalization were excluded. Patient demographics were compared with the demographics of the counties surrounding the hospital. RESULTS 33 patients with BT met inclusion criteria. The most common presenting symptoms were difficulty breathing, stridor, and sore throat (81.8% each), followed by cough (78.8%). Median length of stay was 3 days [interquartile range (IQR):2-4]. 19 patients (57.5%) were admitted to the intensive care unit. Intubation was required for 13 patients (39.4%), for a median length of 2 days [IQR:2-2]. Methicillin sensitive staphylococcus aureus was the most common bacterial etiology (33%). Mean presenting age was 8.58 years [95% confidence interval:7.3-9.9] and 14 patients were female (42.4%). 31 patients were white (93.9%), 1 was black (3%), and 1 was Hispanic (3%). BT patients were more likely to have private insurance compared to comparison (81.8% vs 63.4%, P < .001). CONCLUSION Children who presented with BT were more likely to be privately insured than a comparison population.
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Affiliation(s)
- Jenna H Barengo
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew J Redmann
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatric Otolaryngology, Children's Minnesota, Minneapolis, MN, USA
| | - Patrick Kennedy
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.,Division of Otolaryngology, Cincinnati Children's Hospital Medical, Center, Cincinnati, OH, USA
| | - Matthew M Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.,Division of Otolaryngology, Cincinnati Children's Hospital Medical, Center, Cincinnati, OH, USA
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Chandrakantan A, Mehta D, Adler AC. Pediatric obstructive sleep apnea revisited: Perioperative considerations for the pediatric Anesthesiologist. Int J Pediatr Otorhinolaryngol 2020; 139:110420. [PMID: 33035805 DOI: 10.1016/j.ijporl.2020.110420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
Pediatric obstructive sleep apnea presents in up to 7% of children and represents a constellation from nasal turbulence to cessation in gas exchange. There are numerous end organ sequelae including neurocognitive morbidity associated with persistent OSA. Adenotonsillectomy (AT), the first line therapy for pediatric OSA, has not been demonstrated to reduce all end organ morbidity, specifically neurological and behavioral morbidity. Furthermore, certain at-risk populations are at higher risk from neurocognitive morbidity. Precise knowledge and perioperative planning is required to ensure optimal evidence-based practices in children with OSA. This comprehensive review covers the seminal perioperative implications of OSA, including preoperative polysomnography, pharmacotherapeutics, and postoperative risk stratification.
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Affiliation(s)
| | - Deepak Mehta
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Adam C Adler
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Abstract
Pediatric obstructive sleep apnea affects a large number of children and has multiple end-organ sequelae. Although many of these have been demonstrated to be reversible, the effects on some of the organ systems, including the brain, have not shown easy reversibility. Progress in this area has been hampered by lack of a preclinical model to study the disease. Therefore, perioperative and sleep physicians are tasked with making a number of difficult decisions, including optimal surgical timing to prevent disease evolution, but also to keep the perioperative morbidity in a safe range for these patients.
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Affiliation(s)
- Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, A330, Houston, TX 77030, USA.
| | - Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, A330, Houston, TX 77030, USA
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15
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Kohn JL, Rubin SJ, Patel J, Dia R, Levi JR, Cohen MB. Factors affecting completion of sleep studies in pediatric patients with sleep‐disordered breathing. Laryngoscope 2020; 130:E258-E262. [DOI: 10.1002/lary.28091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/05/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jocelyn L. Kohn
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Samuel J. Rubin
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Jay Patel
- Boston University School of Medicine Boston Massachusetts U.S.A
| | - Reem Dia
- University of Massachusetts Boston Boston Massachusetts U.S.A
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Michael B. Cohen
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
- Department of Otolaryngology–Head and Neck SurgeryVeterans Affairs Hospital Boston Boston Massachusetts U.S.A
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Dang S, Shinn J, Campbell B, Garrett G, Wootten C, Gelbard A. The impact of social determinants of health on laryngotracheal stenosis development and outcomes. Laryngoscope 2020; 130:1000-1006. [PMID: 31355958 PMCID: PMC7808241 DOI: 10.1002/lary.28208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/06/2019] [Accepted: 07/09/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The social determinants of health affect a wide range of health outcomes and risks. To date, there have been no studies evaluating the impact of social determinants of health on laryngotracheal stenosis (LTS). We sought to describe the social determinants in a cohort of LTS patients and explore their association with treatment outcome. METHODS Subjects diagnosed with LTS undergoing surgical procedures between 2013 and 2018 were identified. Matched controls were identified from intensive care unit (ICU) patients who underwent intubation for greater than 24 hours. Medical comorbidities, stenosis characteristics, and patient demographics were abstracted from the clinical record. Tracheostomy at last follow-up was recorded from the medical record and phone calls. Socioeconomic data was obtained from the American Community Survey. RESULTS One hundred twenty-two cases met inclusion criteria. Cases had significantly lower education compared to Tennessee (P = .009) but similar education rates as ICU controls. Cases had significantly higher body mass index (odds ratio [OR]: 1.04, P = .035), duration of intubation (OR: 1.21, P < .001), and tobacco use (OR: 1.21, P = .006) in adjusted analysis when compared to controls. Tracheostomy dependence within the case cohort was significantly associated with public insurance (OR: 1.33, P = .016) and chronic obstructive pulmonary disease (OR: 1.34, P = .018) in adjusted analysis. CONCLUSION Intubation practices, medical comorbidities and social determinants of health may influence the development of LTS and tracheostomy dependence after treatment. Identification of at-risk populations in ICUs may allow for prevention of tracheostomy dependence through the use of early tracheostomy and specialized follow-up. LEVEL OF EVIDENCE Level 3, retrospective review comparing cases and controls Laryngoscope, 130:1000-1006, 2020.
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Affiliation(s)
- Sabina Dang
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Justin Shinn
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin Campbell
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gaelyn Garrett
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher Wootten
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander Gelbard
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee
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