Key points are not available for this paper at this time.
Abstract Introduction Treatment of persistent obstructive sleep apnea (OSA) in medically complex pediatric patients can be challenging due to concurrent developmental delays contributing to poor adherence with positive airway pressure (PAP) therapy. There is limited literature describing a multidisciplinary approach to treating persistent OSA in medically complex pediatric patients utilizing a pulmonologist, otolaryngologist, sleep medicine provider, psychologist, nutritionist, and nurse coordinator. Objectives: 1: Describe the multidisciplinary approach to treating persistent OSA in children at our institution; 2: Review concurrent patient diagnoses and interventions recommended; 3: Report resulting decreased patient costs and increased access to care. Methods We developed a multidisciplinary OSA (MOSA) clinic for patients with recalcitrant OSA in November 2022 in a pediatric tertiary care setting. Patients with persistent OSA after adenotonsillectomy who failed PAP therapy were seen for treatment optimization. This included consideration for drug induced sleep endoscopy (DISE) and/or Hypoglossal Nerve Stimulator (HGNS), as well as an evaluation by sleep psychology, pulmonary medicine, and a sleep provider to improve PAP adherence. Data was collected and reviewed via retrospective chart review. Results Twelve clinic sessions have been completed and 46 pediatric patients have been evaluated (n=46) with an average age of 10. 4 years (±5 years). 58% were referred for nonadherence to PAP therapy. The most prevalent concurrent diagnosis was developmental delay (n=36, 78%). Other diagnoses included Trisomy 21 (n=18, 46%), other genetic disorders (n=8, 17%), and autism (n=6, 13%). 61% (n=46) had 95th%ile BMI-for-age resulting in nutrition consultation. Surgical intervention was recommended for 41% (n=19) while 43% (n=20) were scheduled for ongoing desensitization to PAP therapy. Combining specialties reduced average patient travel by 220 miles and gas costs of 35. 44. Wait times to see the otolaryngologist decreased from 9 months to 3 months. Due to high demand, a second clinic location will launch in February 2024. Conclusion Our MOSA clinic has provided significant value in treating complex pediatric patients with persistent OSA. This review identifies patients with comorbidities that may be good candidates for a multidisciplinary sleep clinic, the potential improvement in access to care, and cost savings for patients and families requiring complex care related to persistent OSA. Support (if any)
Petitto et al. (Sat,) studied this question.