Primary care strategies for the screening of obstructive sleep apnea in children: An integrative review

Obstructive sleep apnea (OSA) is a sleep related breathing abnormality that involves snoring and intermittent breathing pauses. In children, OSA is linked to cardiovascular, metabolic, behavioural, neurocognitive, and academic consequences (Blechner & Williamson, 2016; Tan, Gozal, & Kheirandish-Gozal, 2016). The most common causes of childhood OSA are adenotonsillar hypertrophy and obesity. With the increasing prevalence of childhood obesity, screening for OSA in the primary care setting is essential for early recognition. This integrative review is guided by the research question: what strategies can NPs, as primary care providers, implement to improve screening for OSA in children between the ages of 2-8 years to determine need for referral? A comprehensive literature search was conducted, and 11 pertinent articles were identified to address the research question. During analysis, three major themes to improve childhood OSA screening emerged: 1) use of validated pediatric OSA screening questionnaires; 2) use of subjective and objective variable screening tools; and 3) the feasibility of home based nocturnal oximetry for children with suspected OSA. Synthesis of the literature provides tools primary care providers can use to screen children for OSA, as well as multiple subjective and objective clinical features of childhood OSA. A gap in pediatric sleep services is recognized, which places emphasis on the need for improved childhood OSA screening in the primary care setting. Further research is needed to validate the use of home-based nocturnal oximetry sleep studies for children with suspected OSA. This paper is concluded with additional recommendations for practice, education, and public health to improve childhood OSA screening and achieve early recognition.