Impact of Social Vulnerability on Pediatric Obstructive Sleep Apnea

OBJECTIVES: To evaluate the association between the Social Vulnerability Index (SVI) and pediatric obstructive sleep apnea (OSA) outcomes, including comorbidities, diagnostic timing, and surgical intervention. METHODS: A retrospective review of our institution's TriNetX Research Enterprise Data Warehouse assessed patients aged 0-18 years diagnosed with OSA from 2014 to 2024. Patients were grouped into four SVI quartiles: Low, Low-Medium, Medium-High, and High. Extracted variables included polysomnography (PSG), Continuous Positive Airway Pressure (CPAP), tonsillectomy and adenoidectomy (T&A) surgeries, secondary complications, and the time elapsed between diagnosis and procedures or complications. RESULTS: The study included 5753 patients with an average age of 7.69 years, and 43.9% were in the High SVI quartile. Black or African American patients comprised 75.9% of this highly vulnerable cohort. Overall, 8.7% of the cohort underwent PSG, with no significant differences in testing or time to PSG. There was a significant stepwise increase in comorbid asthma across vulnerability tiers, peaking at 9.4% in the High SVI group (p = 0.001). High SVI patients underwent T&A at significantly higher rates compared to those in the Low (p = 0.008) and Low-Medium (p = 0.002) quartiles. The mean time to surgery was 166.5 days, which did not significantly differ between SVI groups. CONCLUSION: Children in highly vulnerable neighborhoods experienced a disproportionate burden of comorbid asthma and underwent surgical management for OSA at significantly higher rates. This suggests that socially vulnerable patients may present with more severe disease requiring surgery. Incorporating metrics like SVI into clinical pathways can better guide patient-centered care and equitable resource allocation.