Understanding sociodemographic factors related to health outcomes in pediatric obstructive sleep apnea.

OBJECTIVES:(1) To examine relationships between socioeconomic status (SES) and successful treatment of pediatric obstructive sleep apnea (OSA) with adenotonsillectomy (T&A). (2) To explore sociodemographic factors and medical comorbidities that separate OSA and refractory OSA populations in children. METHODS:We retrospectively reviewed pediatric OSA patients (ages 0-18). Patients evaluated for OSA by pediatric otolaryngology between January 2014 and December 2015 were included. OSA was defined as requiring T&A. Refractory OSA (ROSA) was defined as recurring, polysomnography-proven, OSA after T&A, ultimately requiring another intervention, such as a multi-level airway operation. Clinical data were complemented with sociodemographic data. ZIP codes were used to approximate median household income. RESULTS:Our cohort included 105 ROSA and 53 OSA patients. These patients came from similar rates of single parent households and coverage by public insurance. Median household income for OSA patients was $47,086 (IQR $36,395-$60,196), compared to $45,696 (IQR $37,669-$56,203) for ROSA patients. Over 60% of all patients fell below the national household income average. Nearly half of the cohort resided in the three largest metro counties closest to our institution. These patients represented higher rates of single-parent households (p = 0.045) and public insurance (p = 0.002), and trends towards lower rates of ROSA (p = 0.138). CONCLUSION:Our results identified sociodemographic factors that may influence healthcare compliance and subsequently overall health outcomes. We identified no statistically significant difference in measures of SES between patients with refractory vs non-refractory OSA. Patients living closest to our medical center had lowest rates of ROSA, suggesting that access to care may affect outcomes of pediatric OSA.