0778 Sleep-disordered Breathing Among Children with Myelomeningocele: An Opportunity to Improve Clinical Practice

Children with myelomeningocele have multiple risk factors for sleep-disordered breathing (SDB). Our recent work suggests that SDB is ubiquitous in neonates with myelomeningocele; in older patients, SDB may increase the risk of serious health consequences, including sudden death. Many children with myelomeningocele are followed long-term in multidisciplinary clinics where they could be screened for SDB, but we hypothesized that such screening may not occur routinely. To define our center’s current practices in evaluating for SDB, we systematically reviewed the records of all patients with a diagnosis of myelomeningocele who were born between 2012 and 2016 (current ages one to five years) and received care at our tertiary care children’s hospital. There were 86 children with myelomeningocele, 42 of whom were followed in our multidisciplinary myelomeningocele clinic. Fifteen (17%) had a SDB diagnosis recorded on their problem list in the electronic medical record. Of these, four (27%) were diagnosed with obstructive sleep apnea, eight (53%) with central sleep apnea, one (7%) with sleep-related hypoventilation, and three (20%) with other diagnoses. Twenty-five of the 86 had documented polysomnograms (18/25 were conducted as part of a neonatal research protocol, 7/25 for clinical indications). Eleven of the 86 patients (13%) were also referred to pediatric sleep medicine. Ten of the 11 were referred on the basis of abnormal polysomnogram results. Despite increasing awareness of the risk for SDB in children with myelomeningocele, only 9% of patients at our center had either undergone polysomnography on a clinical basis (in the absence of research protocols) or been referred to pediatric sleep medicine. A change in clinical practice to include routine screening of children with myelomeningocele for symptoms of SDB could facilitate early identification of clinically significant SDB and lead to interventions that have potential to improve long-term health and neurodevelopmental outcomes. The University of Michigan Department of Pediatrics Charles Woodson Research Fund supported the database query for this project.