New quality measures for childhood sleep apnea

The American Academy for Sleep Medicine (AASM) has endorsed new quality measures for identifying and treating obstructive sleep apnea (OSA) in children. The measures have been published in the Journal of Clinical Sleep Medicine.

The quality measures, developed by a task force commissioned by AASM and comprised of physicians from academic medical centers nationwide, aim to help make sure that clinicians are following existing best-practice guidelines for recognizing and treating OSA-such as the American Academy of Pediatricsclinical practice guideline-by offering a standard way to evaluate the quality of the services they provide.

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Methods of detecting and managing childhood OSA and assessing outcomes vary across disciplines. To develop quality measures that would allow for this variety while maintaining minimal practice standards, the task force analyzed 960 peer-reviewed journal articles about quality care or metrics in OSA. They then graded the articles on how strongly clinical-care processes were linked to desired outcomes.

By this means they defined 5 desirable processes for managing children with suspected OSA: assessing symptoms and risk factors for OSA; implementing an evidence-based action plan; objectively evaluating high-risk children with OSA using a polysomnogram; reassessing signs and symptoms within 12 months; and documenting objective assessment of adherence to positive airway pressure. Meeting the 5 process measures should lead to better detection of OSA in children and reduce its signs and symptoms, the task force concludes.

The new quality measures offer guidance in using the best diagnosis and treatment practices for childhood OSA, and might help avoid penalties by insurers, especially for healthcare providers who don’t often encounter the condition in their practice. Greater awareness of the measures could prompt parents of children with OSA to check that their child’s doctor is following recommended practice. Quality metrics also could help health insurers better monitor the documented clinical practices of providers.

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As many as 5% of children in the United States are believed to suffer from OSA, perhaps even more inasmuch as the condition often goes undetected. The major causes are enlarged tonsils or adenoids, craniofacial abnormalities, obesity, and genetic conditions such as Down syndrome.

The sleep disruption caused by OSA is associated with mood changes such as irritability, learning and behavior problems, metabolic syndrome (characterized by hypertension, abnormal blood lipid levels, and development of type 2 diabetes), and hormone imbalances resulting in weight gain. Untreated childhood OSA increases the risk of heart attack later in life.