Unscheduled health care visits in children with obstructive sleep apnea and the impact of positive airway pressure therapy

Abstract

PURPOSE: Untreated OSA in children leads to health complications and unscheduled acute health care visits. We aimed to determine the frequency of unscheduled health care visits and costs in children with OSA and the impact of PAP therapy.

METHODS: We linked the sleep database at the Children’s Hospital of Eastern Ontario, in Ottawa, Canada, with provincial health administrative data between April 1, 2009 and March 31, 2013. We compared mean annual unscheduled health care visits in a cohort of children 0 − 7 years old with OSA who were eligible for PAP therapy to matched controls without OSA. We further compared unscheduled visits and costs 12 months after starting PAP in this same cohort.

RESULTS: We matched 45 children with untreated OSA with 90 controls. Children with OSA had a higher mean number of emergency department visits (1.18/year vs 0.63/year, p < 0.01) and hospital admissions (0.62/year vs. 0.14/year, p < 0.01) compared to controls. The mean number of emergency department visits (1.13/year vs. 0.86/year, −0.27 mean difference, 95%CI −0.71, 0.17), hospitalizations (0.76/year vs 0.55/year, −0.2 mean difference, 95%CI =-.57, 0.17), and mean annual health care costs did not change significantly after initiation of PAP therapy.

CONCLUSIONS: We observed that children with untreated OSA have a higher frequency of unscheduled acute health care visits, but the initiation of PAP did not significantly reduce this.

RÉSUMÉ

OBJECTIF: L’apnée obstructive du sommeil (AOS) non traitée chez les enfants entraîne des complications de santé et des visites de soins de santé aigus imprévues. Nous visions à déterminer la fréquence des visites de soins de santé imprévues et les coûts chez les enfants atteints d’AOS, ainsi que l’effet de la thérapie par pression positive des voies respiratoires (PAP).

MÈTHODES: Nous avons lié la base de données sur le sommeil du Centre hospitalier pour enfants de l’Est de l’Ontario, à Ottawa, au Canada, aux données administratives provinciales sur la santé entre le 1er avril 2009 et le 31 mars 2013. Nous avons comparé la moyenne annuelle des visites de soins de santé non programmées dans une cohorte d’enfants de 0 à 17 ans atteints d’AOS qui étaient admissibles au traitement PAP à des témoins appariés sans AOS. Nous avons en outre comparé les visites imprévues et les coûts 12 mois après le début de la thérapie PAP dans cette même cohorte.

RÈSULTATS: Nous avons apparié 45 enfants avec AOS non traitée avec 90 témoins. Les enfants atteints d’AOS avaient un nombre moyen de visites aux urgences (1,18 / an comparativement à 0,63 / an, p < 0,01 ) et d’hospitalisations (0,62 / an comparativement à 0,14 / an, p 0,01) plus élevé que  les témoins. Le nombre moyen de visites aux urgences (1,13 / an comparativement à 0,86 / an, − 0,27 différence moyenne, IC à 95 % −0,71, 0,17), les hospitalisations (0,76 / an comparativement à 0,55 / an, − 0,2 différence moyenne, IC à 95% = - 0,57, 0,17) et les coûts annuels moyens des soins de santé n’ont pas changé de manière significative après le début de la thérapie PAP.

CONCLUSIONS: Nous avons observé que les enfants souffrant d’AOS non traité ont une fréquence plus élevée de visites non programmées pour des soins de santé aigus, mais l’initiation du PAP n’a pas réduit significativement cette fréquence.

Keywords:

• Children
• health care utilization
• obstructive sleep apnea
• positive airway pressure

Acknowledgment

The authors would like to acknowledge the contribution of Linda Hoey in her assistance with development of the CHEO Sleep Database. This work was performed at the Children’s Hospital of Eastern Ontario Research Institute and at ICES uOttawa, Ottawa, Ontario, Canada.

Competing interests

No authors have any competing interests to declare. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s) and not necessarily those of CIHI.

Additional information

Funding

This study was supported by ICES, which is funded by an annual grant from the MOHLTC. In-kind support for statistical analysis was provided by the OCHSU CHEO site and the Children’s Hospital of Eastern Ontario Research Institute.