48 - Improving ambulatory sleep assessments in infants presenting with aerodigestive disorders

Poster Number: 48
Publication Number: 48.3003

Background: Prior AAP and NASPGHAN guidelines have noted that infants with gastroesophageal reflux or enterally tube dependence should follow safe sleep guidelines, with exceptions for infants with high risk airway disorders.

Objective: To complete a quality improvement project aimed at improving the frequency of Aerodigestive infants undergoing a standardized sleep questionnaire from 0% to >80% by November 30, 2023.

Design/Methods: A multidisciplinary team of providers were assembled from our ambulatory Aerodigestive Center (ADC). A written sleep questionnaire was revised and then distributed throughout our five ADC clinics to parents of any infant < 15 months age. Plan-do-study-act intervention cycles were developed around ensuring accurate identification of infants/families, promoting reliable and equitable survey administration, and education of clinical staff (Key Driver Diagram, Figure 1). Primary outcome measure was frequency of infants offered the sleep questionnaire. Secondary outcomes included parental sleep responses to sleep positioning (whether flat and supine), as well as parental sleep concerns (gastrointestinal, respiratory, discomfort, other concern). Balancing measures included: frequency of sleep studies ordered within 3 months of initial clinic visit and frequency of hospitalization to gastroenterology or pulmonary medicine within 30 days of initial clinic visit.

Results: 205 screening questionnaires were administered to 140 unique patients. 8 (5.7%) used a language other than English. Median age at time of first survey screen: 6.97 (4.1, 11.4) months with 21 (15%) on supplemental oxygen, 87 (62.1%) with an abnormal swallow study, 102 (72.9%) with gastroesophageal reflux, and 112 (80%) orally fed and 62 (44.3%) requiring enteral assistance. Frequency of infants undergoing a sleep questionnaire screen increased from a mean of 24% to 84% (Figure 2). Sixty seven (32.7%) parents reported a sleep concerns. No changes in frequency of ordered sleep studies or hospital admissions were seen. Use of enteral tube feeding (p=0.01), presence of oropharyngeal abnormality (p=0.008), and parental respiratory concern (p=0.03) significantly increased impacted parental use of upright positioning (Table 1).

Conclusion(s): Implementation of a standardized sleep questionnaire is feasible within a multi-disciplinary aerodigestive program. Use of enteral tube feeds, presence of oropharyngeal abnormalities, and respiratory concerns impacted parental use of a flat sleep position. Further initiatives are needed to better address parental sleep concerns in patients with aerodigestive disorders.