A Survey About Clinicians, Knowledge And Attitudes About Obstructive Sleep Apnea In Children

Objective:through six basic points of children with obstructive sleep apnea syndrome on epidemiology, pathophysiology, symptoms, diagnosis, complications and treatment as the degree of master points,and hierarchical classification which was graded through the level of awareness of three aspects:the significance of children with OSAHS, the capabilities of diagnosis and treatment, self-assessment of self-confident state, to assess physicians'knowledge and attitudes about childhood OSAS and its treatment.With a view to improve clinicians'recognition ability of OSAHS, to determine the appropriate diagnostic procedures, the identification of related risk factors and the evaluation of treatment options of OSAHS.Method:Adopted American questionnaire of knowledge and attitudes about obstructive sleep apnea in children as the basic model, a total of 391 clinicians from otolaryngological department or pediatric department of 43 public hospitals in Shandong Province were involved in this survey in May to October in 2009.Results:1. The knowledge of OSAHS is remained to be improved, basic knowledge scores from highest to lowest order of pathophysiology, complications, diagnosis, treatment, epidemiology, clinical manifestations2. Only a little bit more than one fifth (24.3%) of clinicians know that the severity of OSAHS has no concern with the degree of snoring, and the correct answer rate of "both central and obstructive apnea in infants can be reliably detected by a cardio respiratory monitor" was only 16.11%.3. Clinicians from otolaryngological department and pediatric department show no significance difference in the total score of the knowledge about OSAHS in children. However, But there are statistically significant differences in the following two items: ENT clinicians got higher rate in "more than 2% of children have OSAHS", and pediatrics clinicians had more correct views about "Obstructive sleep apnea in children may be associated with pulmonary hypertension".4. Total knowledge scores did not differ significantly by gender. But the diagnostic knowledge scores are higher in women than males.5. Total knowledge scores had no significant correlations with educational background or professional ranks and titles, but with the hospital level. The average scores of epidemiology and diagnosis had no significant difference in clinicians of different hospital. Doctor of provincial hospital got higher accuracy rate than physicians of country hospital in general knowledge scores, pathphysiological knowledge. Clinical performance scores were higher in doctor of provincial and country hospital than in municipal hospital. The average scores of knowledge about complications decreased according to the rank of hospital.6.Total correct answer rate, self-esteem and self-evaluation grade, and the total attitude scores had low linear correlation with Physician age and length of time engaged in clinical work.7. More than two thirds of clinicians considered that it was important, very important or extremely important to diagnosis of children with the OSAHS. Only less than one third of doctors feel confident in the diagnosis and treatment of children with OSAHS. Awareness of the importance of disease had no correlation with age, length of time engaged in clinical work, job title, education background, gender, but had rank correlation with self-confidence of diagnosis and treatment of OSAHS.8. ENT and pediatricians had no significant difference in recognize the importance of the understanding in "OSAHS is a clinical disorder "and " diagnosis of children with the OSAHS ". However, self-assessment and self-confidence of ENT physicians was significantly higher than pediatricians in diagnosis of OSAHS risk children and treatment in children of OSAHS.9. Experts including chief physicians and deputy chief physicians got higher scores than residents in the scale of self-confidence, and the rank of overall attitude; self-evaluation in the education background of master, undergraduate, associate bachelor degrees were higher than Ph.D. level clinicians.10. The following points such as correct answer rates, epidemics, pathophysiology, clinical manifestations, diagnosis, and the basic knowledge of treatment had low positive correlations with the attitude of total self-evaluation scores, and the average recognition of the importance of disease. Besides, these points except pathophysiology had low positive correlations with the average score of self-esteem. This shows that the more knowledge they master, the more positive attitude towards self-evaluation.11. There were negative rank correlations between self-confidence of clinicians and education levels. Self-confidence was correlated with the level of clinical titles. Namely, lower education, diagnosis and treatment of the disease the higher the self-confidence self-evaluation; title of the higher diagnosis and treatment of the disease the higher the self-evaluation self-confidence.12. About two thirds of clinicians in our survey never used CPAP, but only 30.69% of clinicians were confident in dealing with CPAP treatment in children with OSAHS. Clinicians who were confident in diagnosis and treatment had more capability in CPAP treatment. The self-confidence of CPAP treatment of clinicians had no relationship with gender, education background and work units, but has negative rank correlation with professional titles. There were no significance differences in self-confidence of dealing with children underwent CPAP therapy between ENT doctors and pediatricians.Conclusion:1. Clinicians at all levels should redouble their efforts to study relevant knowledge, especially in the clinical manifestations of sleep disorder, PSG and CPAP treatment.2. With age and working hours increasing, the ability of clinicians to understand and deal with the disease increased accordingly. The more emphasis on OSAHS, the more positive attitude, knowledge scores they got.3. Continuing education of children with OSAHS for clinicians in primary hospitals need to be further strengthened.4. Operative risk assessment should be emphasized in tonsillectomy and adenoidectomy.5. Pediatricians should increase their self-confidence in diagnosis and treatment.6. Effectiveness of the CPAP treatment of children with OSAHS should be advertised widely, so that clinicians at all levels understand the indications, complications of treatment, and its positive efficiency.