Prolonged Morbidity Due to Delays in the Diagnosis and Treatment of Obstructive Sleep Apnea in Children

Abstract

The inclusion of a query concerning the presence of snoring in a questionnaire used by the Allergy Service of Childrens Hospital Los Angeles (CHLA) uncovered a significant number of patients who were experiencing prolonged and discomforting symptoms owing to previously undiagnosed obstructive sleep apnea (OSA) caused by adenotonsillar hypertrophy. Of 352 patients who were discharged with a diagnosis of OSA and tonsillectomy and/or adenoidectomy at CHLA in 1996-1997, a retrospective study of the first 45 randomly selected patients who agreed to participate in a telephone interview was performed. Analysis revealed that all patients experienced severe and discomforting symptoms with all describing severe or moderate snoring. Other symptoms included chronic mouth breathing (84%), frequent otitis media (64%), sinusitis (56%), sore throat (51%), choking (47%), and daytime drowsiness (42%). Other symptoms included poor school performnce, enuresis, poor appetite and/orxweight gain, dysphagia, and vomiting. Symptoms began at a mean age of approximately 2 years (”birth“-9 years), and the mean period of time between the development of significant symptoms and OSA was 3.3 years (6 months-1 3 years). Delay between onset of significant symptoms and surgery was>1 year in 82% of the patients,>2 years in 51% of the patients,>4 years in 31% of the patients, and>6 years in 13% of the patients. Forty percent of patients were self-referred to an otolaryngologist for treatment despite their primary care physician being aware of the symptoms. These results indicate that patient with OSA experienced prolonged morbidity and delays in treatment, which is probably widespread. Physican, parent, and third-party factors were found to have contributed to the delays in treatment.