Transition to Adult Care for Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea may occur throughout the lifespan, with peak occurrences in early childhood and during middle and older age. Onset in childhood is overwhelmingly due to adeno-tonsillar hypertrophy, while in adulthood, contributors include risk factors, such as obesity, male sex, and aging. More recently, there has been a precipitous increase in the prevalence of obstructive sleep apnea in youth. Drivers of this phenomenon include both increasing obesity and the survival of children with complex medical conditions into adulthood. Appropriate treatment and long-term management of obstructive sleep apnea is critical to ensure that these youth maintain well-being unfettered by secondary comorbidities. To this end, patient engagement and seamless transition of care from pediatric to adult health care systems is of paramount importance. To date, this is an unacknowledged and unmet need in most sleep programs. This article highlights the need for guideline-driven sleep disorder transition processes and illustrates the authors’ experience with the development of a program for sleep apnea.

Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care

“…46 The current SlePT clinic was established due to an increase in pediatric patients with OSA requiring ongoing adult care and to streamline the transition of young adults with sleep disorders to the adult healthcare system. 14 The results from our study suggest that further modification and evaluation of the program is required to improve patient participation with the health-care team and their OSA treatment. This is important as emerging evidence in youth with OSA indicates that OSA is an independent risk factor for cardiovascular and metabolic disease, poorer psychosocial functioning and lower QOL.…”

“…The sleep clinics at both sites incorporate recommended guidelines and processes for transition of care. 14 Prior to transition, all patients underwent routine otolaryngology assessment and if required treatment. Dental, medical weight loss and assessment for bariatric surgery were performed if warranted.…”

Pediatric Sleep-Disordered Breathing and Long-Term Complications: Clinical and Health Implications

“…As the incidence of pediatric patients at high risk of OSAS increases, a growing number of young adults will require long-term medical transition follow-up. Heffernan et al reported that a transition program has been implemented in Canada for some years in adolescent patients with OSAS [ 27 ]. The adequate training of healthcare professionals and the implementation of transition programs are essential.…”