0878 Assessment of Accessibility to Diagnosis of Pediatric OSA Using Portable Home Sleep Study Testing Versus In-Lab Polysomnography

Abstract Introduction Untreated pediatric obstructive sleep apnea (OSA) can cause significant morbidity, making timely diagnosis essential. In-lab polysomnography (ILP) is the gold standard but is often limited by availability and long waiting times. Our study aimed to assess accessibility to OSA diagnosis using a type III home sleep study (HST) compared to ILP. Methods We conducted a retrospective review of patients under 21 years who completed HST from May to October 2025. HST was ordered for children with high clinical suspicion for moderate to severe OSA. A group of similarly aged patients who underwent ILP during the same period was randomly selected. Demographics, comorbidities, sleep study parameters, and logistical metrics (time for authorization, study completion, and result review) were collected. Results Forty-seven patients were included (HST: 23 [female 9, male 14]; ILP: 24 [female 10, male 14]), median age of 9 years for HST [range 1-18 years] and 8.5 years for ILP [range 2-17 years]). HST group had a slightly higher prevalence of asthma (61% versus 42%), chromosome abnormalities (43 % versus 29%), autism (30% versus 20%), cardiac pathologies (26% versus 13%), and prematurity (22% versus 8%), whereas ILP group had higher prevalence of seasonal allergies (30% versus 38%) and obesity (22% versus 25%). The median time from order to study was 30 days (range 6 to 123 days) for HST and 143 days (range 84 to 231 days) for ILP; time to results was 44 days (range16 to 145 days) for HST and 174 days (range 174 to 275 days) for ILP. OSA severity distribution for HST group: 1-primary snoring, 9-mild, 15-moderate, 5-severe versus ILP group: 0-primary snoring, 15-mild, 5-moderate and 4-severe. In the HST group, severity was likely underestimated for 8 (35%) patients since respiratory events could not be scored even with airflow limitation due to absence of electroencephalography signals. Conclusion HST improved access to diagnosis with a significant reduction in wait time to obtain the study as well as results even in children with significant co-morbidities. HST likely underestimated the severity of OSA for some. Further clinical guidelines are needed for the use of HST as a diagnostic modality in pediatric OSA. Support (if any)