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Vol. 68. Issue 6.
Pages 336-343 (November - December 2017)
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Vol. 68. Issue 6.
Pages 336-343 (November - December 2017)
Original article
DOI: 10.1016/j.otoeng.2017.10.005
Lessons from Healthcare Utilization in Children With Obstructive Sleep Apnoea Syndrome
Aprendiendo de la demanda asistencial en el síndrome de apnea del sueño infantil
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Paz Martinez-Beneytoa,
Corresponding author
pazmabe@gmail.com

Corresponding author.
, Cristina E. Soria Checab, Paloma Botella-Rocamorac, Inés Rincon-Piedrahitaa, Francisco J. Garcia Callejoa, Jaime Marco Algarraa
a Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, Spain
b Servicio de Otorrinolaringología, Hospital General de Onteniente, Onteniente, Valencia, Spain
c Área de Epidemiología, Dirección General de Salud Pública, Valencia, Spain
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Figures (1)
Tables (7)
Table 1. Demographic Parameters and Sleep Study in the OSAS Group of Children.
Table 2. Treatment Type and Outcome for the Different Degrees of OSAS.
Table 3. Frequency Averages Over the 5 Year Follow-up Period.
Table 4. Total Visits According to OSAS Severity During the 5 Year Follow-up.
Table 5. Total Visits According to Type of Treatment During the 5 Year Follow-up.
Table 6. Average Values of Frequency During the 5 Years of Follow-up According to Evolution After Treatment.
Table 7. Diagnosis Made in the Healthcare Service Surgeries During the 5 Year Follow-up.
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Abstract
Introduction and objectives

Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. Objective: to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population.

Methods

A longitudinal, case–control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment (“Year 0”), 1 and 2 years before (“Year −1” and “Year −2” respectively), and 1 and 2 years after treatment (“Year +1” and “Year +2”).

Results

Frequentation index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year −2, and 2.15 during Year −1 (P<.05). Treatment diminishes utilisation, with FI of 159 during Year +1 and 1.72 during Year +2 (P<.05). The main causes of attendance were otolaryngological and pneumological diseases, improving after treatment.

Conclusions

Children suffering from OSAS demand more healthcare services, at least 2 years before treatment, implying that the disease could be present years before we manage it. Therapeutic actions improve healthcare services utilisation, although remain higher than for controls, which suggests OSAS sequelae or residual disease.

Keywords:
Sleep apnoea syndromes
Child health
Health services needs and demand
Health care utilisation
Resumen
Introducción y objetivos

El síndrome de apnea-hipopnea del sueño (SAHS) pediátrico engloba alteraciones multisistémicas que afectan al estado general de salud, valorado indirectamente mediante el estudio de la demanda asistencial. Objetivo: cuantificar la frecuentación de consultas médicas en niños con SAHS durante 5 años y compararla con una población sana.

Métodos

Estudio casos-control longitudinal ambispectivo en un hospital del sistema nacional de salud. Reclutamos a 69 niños remitidos por SAHS sin otras patologías para que la demanda asistencial fuera predominantemente atribuida al SAHS. Se seleccionó a otros 69 niños sanos como grupo control. Obtuvimos datos de frecuentación durante 5 años: el año en el que se realizó el tratamiento del SAHS («año 0»), 1 y 2 años antes («año –1» y «año –2»), y 1 y 2 años tras el tratamiento («año+1» y «año+2»).

Resultados

El índice de frecuentación (IF), descrito como cociente entre demanda asistencial por los niños con SAHS y niños sanos, fue 1,89 durante el año –2 y 2,15 durante el año –1 (p < 0,05). El tratamiento disminuyó la utilización, con IF de 1,59 durante el año +1 y 1,72 en el año +2 (p < 0,05). Las principales causas de sobrefrecuentación fueron otorrinolaringológicas y neumológicas.

Conclusiones

Los niños con SAHS muestran mayor demanda asistencial, al menos 2 años antes del tratamiento, lo que implica un deterioro de la salud global que pudiera estar presente años antes de que la abordemos. El tratamiento repercute en una mejora, aunque permanece alta tras el tratamiento, sugiriendo enfermedad residual o secuelas.

Palabras clave:
Síndrome de apnea del sueño obstructiva
Salud del niño
Necesidad y demanda de servicios de salud
Utilización de servicios de salud

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