Evidence-based decision making found lacking in sleep apnea management
Most care decisions for the management of obstructive sleep apnea (OSA) in children are based on widely varying clinical experience rather than being evidence-based, including when to refer patients for subspecialty clinic follow-up and when to order follow-up overnight-sleep studies, according to research led by members of the Division of Otolaryngology.
The research team presented new findings from an ongoing research effort at the Triological Society Combined Sections Meeting in San Diego in January 2015. One article based on the presented findings has been accepted for publication in The Laryngoscope, while another has been submitted to the journal Otolaryngology – Head & Neck Surgery.
In the initial, smaller study, Stacy Ishman, MD, MPH, led a team that examined 324 decisions on 58 patients made at clinics and care conferences over a one-week period. Subspecialists explained the basis of their decisions, which were then classified into 10 categories. The findings: only 34 percent of decisions were evidence-based, while 59 percent were non-evidence-based and 7 percent were based on parental preference. Providers were able to cite specific studies for less than 20 percent of their decisions.
In a companion study for The Laryngoscope, the team analyzed these gaps over a two-month period. That study of 507 decisions found that the proportion of non-evidence-based decisions actually increased two percentage points from the shorter study.
The most common non-evidence-based decisions analyzed included the timing and appropriate subspecialty clinic follow-up location (38 percent), as well as indications for overnight-sleep studies (11 percent), especially in children at high-risk for persistent OSA such as those with Down syndrome or obesity. Additional gaps included the likelihood of OSA improvement from weight loss and the effectiveness of sleep surgical procedures.
