title: Elevated morbidity and health care use in children with obstructive sleep apnea syndrome.
abstract: BACKGROUND
  Health care use, a reliable measure of morbidity, is noticeably higher 1 yr before obstructive sleep apnea syndrome (OSAS) diagnosis in preschool children. It is not clear at what age OSAS-related morbidity becomes expressed.
  
  
  OBJECTIVE
  To explore morbidity and health care use among children with OSAS starting from first year of life.
  
  
  METHODS
  Case-control study, starting from the first year of life to date of OSAS diagnosis, among 156 patients (age range, 3-5 yr) and their pair-matched healthy control subjects, by age, sex, primary care physician, and geographic location.
  
  
  METHODS
  Patients with OSAS underwent nocturnal polysomnography studies. Medical records during hospital visits were reviewed for diagnosis. Variables of health care use were obtained from computerized databases of Clalit Health Care Services, the largest health maintenance organization in Israel.
  
  
  RESULTS
  From the first year of life to date of OSAS diagnosis, children with OSAS had 40% more (p = 0.048) hospital visits, 20% more repeated (two or more) visits (p < 0.0001), and higher consumption of antiinfective and respiratory system drugs (p < 0.0001). Referrals of children with OSAS to otolaryngology surgeons and pediatric pulmonologists were higher from Year 1 (p < 0.0001) to date of OSAS diagnosis, especially in Year 4 (odds ratio, 9.4; 95% confidence interval, 4.2-21.1). The 215% elevation (p < 0.0001) in health care use of the OSAS group was due mainly to higher occurrence of respiratory tract morbidity (p < 0.0001).
  
  
  CONCLUSIONS
  Practitioners should be aware that starting in Year 1 until date of diagnosis, children with OSAS have higher health care use, mostly related to respiratory diseases.
authors.affiliation: Department of Physiology, Faculty of Health Sciences, P.O. Box 653, Ben-Gurion University of the Negev, Beer-Sheva, Israel. tarasiuk@bgu.ac.il
authors.forename: Ariel
authors.initials: A
authors.lastname: Tarasiuk
authors.forename: Sari
authors.initials: S
authors.lastname: Greenberg-Dotan
authors.forename: Tzahit
authors.initials: T
authors.lastname: Simon-Tuval
authors.forename: Bruria
authors.initials: B
authors.lastname: Freidman
authors.forename: Aviv D
authors.initials: AD
authors.lastname: Goldbart
authors.forename: Asher
authors.initials: A
authors.lastname: Tal
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
mesh_terms: D016022:Case-Control Studies; D002654:Child Care / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*