Too Few Children With Overweight/Obesity Assessed for Obstructive Sleep Apnea
A study presented at the Pediatric Academic Societies 2026 Meeting in Boston found that children with overweight or obesity are less likely to be evaluated for obstructive sleep apnea (OSA) unless they meet specific demographic or clinical factors like English-speaking families, public insurance, or being aged 2-5. Researchers, including Mona Sharifi from Yale School of Public Health, highlighted disparities in screening and called for system-level interventions like electronic health record reminders to improve equitable evaluations.
Researchers at the Pediatric Academic Societies (PAS) 2026 Meeting in Boston revealed disparities in obstructive sleep apnea (OSA) evaluations among children with overweight or obesity. The study, involving three U.S. health systems in the Northeast, South, and Midwest, analyzed electronic medical records of 119,639 pediatric patients aged 2-18 with a BMI at or above the 85th percentile, seen between 2023 and 2025. Only certain groups—such as those with English as a primary language, public insurance, male sex, non-Hispanic White race, ages 2-5, or higher BMI—were more likely to receive OSA evaluations. The findings surprised lead author Antony Lin, a Yale School of Public Health graduate, particularly the higher evaluation rates for younger children (2-5 years) and those with public insurance. Mona Sharifi, senior author and associate professor at Yale, emphasized the need for system-wide changes, including electronic health record nudges and patient portal reminders, to address missed opportunities in marginalized subgroups. The study noted that despite recommendations from the American Academy of Pediatrics and the American Academy of Sleep Medicine, OSA evaluations remain inconsistent, with prevalence estimates among obese children ranging from 13% to 59%. The research team examined OSA evaluations through diagnoses, polysomnogram orders, or specialist referrals across 81 primary care practices. Key demographic factors—such as race, insurance type, and age—significantly influenced evaluation rates, with non-Hispanic White patients (29.8%) and non-Hispanic Black patients (33.6%) making up the largest groups in the study. The authors stressed the importance of clear clinical guidelines and decision-support tools to help primary care physicians identify eligible children for OSA assessments. Sharifi warned that current disparities create missed opportunities for historically marginalized groups, calling for interventions to ensure equitable screening. The study’s unexpected results, like higher evaluation rates for younger children, suggest potential influences such as rapid adenoid and tonsil growth or parental symptom reporting. The research underscores gaps in primary care practices and the urgent need for standardized approaches to improve OSA detection in at-risk pediatric populations.
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