1. Disparities in treatment of pediatric sleep disordered breathing
Eden Mekonnen and Phayvanh Pecha
Epidemiology I

2. Background and significance
Sleep disordered breathing (SDB) is a prevalent condition that affects approximately 12% of children and ranges from snoring to obstructive sleep apnea (OSA).
Untreated childhood OSA is associated with cognitive deficits, hyperactivity, inflammation, and adverse cardiovascular changes.
Guideline recommended first-line treatment is tonsillectomy with or without adenoidectomy (TA), which is the most common major ambulatory surgery in the US.
Surgical treatment with TA leads to improvement in school performance to behavior to quality of life.

3. Background and significance
Despite the benefits of this highly efficacious treatment for OSA, affected children disproportionately undergo.
Minority and low socioeconomic status have been associated with increased prevalence of SDB, yet these very children experience delayed care and undergo lower rates of surgery.
South Carolina has been identified as having disparities in rural, underserved areas as far as cancer, stroke and diabetes, however this area of disparities has not been explored for SDB.

4. Hypothesis Hypothesis:
Children that live in underserved areas of South Carolina have lower rates of adenotonsillectomy and longer wait times to surgery.
Exposure:
underserved as defined by a social deprivation index by the census track
Outcome:  
time to treatment from recommendation of surgery (per clinic note) to adenotonsillectomy

5. Study design and population
Retrospective cohort study
Target population: patients 2 to 18 years with SDB that were recommended adenotonsillectomy at MUSC in Follow-up period is 2 years.
Source population: children that were diagnosed with obstructive sleep apnea at MUSC in the EMR.
Inclusion criteria will include children <18 years with a diagnosis of sleep disordered breathing by ICD code and that were recommended adenotonsillectomy.
Exclusion criteria: patients >18 years of age, children that did not warrant surgery based on symptoms or sleep study, or those that did not undergo adenotonsillectomy.

6. Limitations Will not capture patients that underwent surgery elsewhere
Limited to tertiary children’s hospital
Enough power?

7. References
Boss EF, Smith DF, Ishman SL. Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children. Int J Pediatr Otorhinolaryngol 2011; 75:
Boss EF, Benke JR, Tunkel DE, Ishman SL, Bridges JF, Kim JM. Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing. JAMA Otolaryngol Head Neck Surg 2015; 141:
Kum-Nji P, Mangrem CL, Wells PJ, Klesges LM, Herrod HG. Black/white differential use of health services by young children in a rural Mississippi community. South Med J 2006; 99:
Morton S, Rosen C, Larkin E, Tishler P, Aylor J, Redline S. Predictors of sleep- disordered breathing in children with a history of tonsillectomy and/or adenoidectomy. Sleep 2001; 24: