0883 Standardized Screening for OSA in Children with ADHD in the Outpatient Clinic: A Quality Improvement Initiative

Abstract Introduction Obstructive sleep apnea (OSA) has an estimated prevalence of 2-5% in the general pediatric population. However, rates of OSA amongst children with attention deficit hyperactivity disorder (ADHD) are significantly higher, with an estimated prevalence of 20-30%. This is clinically significant as there is overlap between symptoms of OSA and ADHD, and untreated OSA can contribute to worsened behavioral and cognitive outcomes. While there is no universally recommended tool for screening of OSA by the American Academy of Pediatrics (AAP) or American Academy of Sleep Medicine (AASM) for children with ADHD, both governing bodies recommend universal screening for OSA in this higher risk population. This quality improvement (QI) project aimed to standardize and increase screening for OSA in children with ADHD and increase the number of appropriate referrals to sleep medicine for OSA in these children by implementing tiered Plan-Do-Study-Act (PDSA) cycles. Methods Retrospective chart review was performed in August 2025 to establish baseline rates of screening for OSA in children with ADHD. The initial intervention instituted was to meet with outpatient pediatric providers to discuss the relationship between OSA and ADHD, with ongoing and subsequent PDSA cycles planned. Chart review cycles were performed in 3-week intervals to assess the efficacy of these interventions in increasing standardized screening and appropriate referral for OSA in children with ADHD. Results During baseline chart review of ADHD encounters from the outpatient pediatric clinic, 22% (8/36) of pediatric ADHD encounters specifically screened for OSA. Of these, 0 screened positive for OSA and none were referred to sleep medicine. After the first PDSA cycle, screening for OSA decreased to 12% (3/25), 0 screened positive for OSA and there were no referrals to sleep medicine. Conclusion This ongoing QI project suggests that diagnoses of OSA in children with ADHD are being missed due to low rates of standardized screening for OSA specifically. Low rates of screening for OSA led to zero referrals to sleep medicine at baseline and after the first intervention. Planned PDSA cycles to improve OSA screening and referral include implementing a standardized OSA screening tool, and standardized autotext in the electronic medical record for screening questions. Support (if any)