Published ahead of print on October 12, 2006, doi:10.1164/rccm.200604-577OC Am. J. Respir. Crit. Care Med., Volume 175, Number 1, January 2007, 55-61 A more recent version of this article appeared on January 1, 2007
Submitted on April 30, 2006 Elevated Morbidity and Health Care Utilization in Children with Obstructive Sleep Apnea SyndromeAriel Tarasiuk1*,1 Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Soroka University Medical Center, Faculty of Health Sciences, Beer-Sheva, Israel; Department of Physiology, Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer-Sheva, Israel, 2 Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Soroka University Medical Center, Faculty of Health Sciences, Beer-Sheva, Israel; Department of Epidemiology, Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer-Sheva, Israel, 3 Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Soroka University Medical Center, Faculty of Health Sciences, Beer-Sheva, Israel; Department of Economics, Ben-Gurion University of the Negev, Faculty of Humanities and Social Sciences, Beer-Sheva, Israel, 4 Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Soroka University Medical Center, Faculty of Health Sciences, Beer-Sheva, Israel, 5 Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Soroka University Medical Center, Faculty of Health Sciences, Beer-Sheva, Israel; Department of Pediatrics B, Soroka University Medical Center, Beer-Sheva, Israel, 6 Department of Health Systems Management, Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer-Sheva, Israel * To whom correspondence should be addressed. E-mail: Tarasiuk{at}bgu.ac.il.
Rationale: Health care utilization, a reliable measure of morbidity, is noticeably higher one year prior to obstructive sleep apnea syndrome (OSAS) diagnosis in preschool children. It is not clear at what age OSAS-related morbidity becomes expressed.
Objective: To explore morbidity and health care utilization among children with OSAS starting from first year of life.
Methods: Case-Control study, starting from the first year of life to date of OSAS diagnosis, among 156 patients (age range 3-5 years) and their paired-matched healthy controls, by age, gender, primary care physician, and geographic location.
Measurements: OSAS patients underwent nocturnal polysomnography studies. Medical records during hospital visits were reviewed for diagnosis. Variables of health care utilization were obtained from computerized databases of Clalit Health Care Services, the largest Health Maintenance Organization in Israel.
Main Results: From first year of life to date of OSAS diagnosis, children with OSAS had 40% more (p=0.048) hospital visits, 20% more repeated ( Key words: Children, Respiratory tract morbidity, Heath Care Utilization, OSAS
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2) visits (p<0.0001), and higher consumption of anti-infective and respiratory system drugs (p<0.0001). Referrals of OSAS children to otolaryngology surgeons and pediatric pulmonologists were higher from year one (p<0.0001) to date of OSAS diagnosis, especially in year four (OR, 95% CI, 9.4, 4.2-21.1). The 215% elevation (p<0.0001) in health care utilization of the OSAS group was mainly due to higher occurrence of respiratory tract morbidity (p<0.0001).
Conclusions: Practitioners should be aware that starting in year one until date of diagnosis, children with OSAS have higher health care utilization mostly related to respiratory diseases.
