A survey around the Italian pediatric units on current clinical practice for Sleep Disordered Breathing (SDB)

SDB Working Group developed a simple questionnaire not yet validated. The questionnaire was costructed by adapting other existing and validated questionnaires for assessing sleep knowledge in a medical education setting [3‐5].

This questionnaire has been drawn up, comprising 11 easy-to-fill questions for the Italian PUs. The questionnaire (attached Additional file 1), excluding demographic data, was structured in four main sections: Awareness about SDB burden (section A), Attitude concerning the workout for SDB diagnosis (section B), Practice on the SDB treatment approach (section C), Satisfaction assessing feelings of personal competence about the management of SDB (section D).

The data collection phase was performed from January to December 2016.

The questionnaire was sent by e-mail to 180 PUs in Italy and re-mailed after 3 months to the PUs who had not previously answered. The 180 PUs were researched through the Federazione Italiana delle Associazioni e Società Scientifiche dell’Area Pediatrica (FIARPED, http://​www.​fiarped.​it/​go/​mission).

A total of 102 Italian PUs completed the questionnaire (out of 180, 56.6%); A total of 53 PUs in the Northern Italy (51.9%), 13 in Center Italy (12.7%) and 36 in the Southern Italy (35.2%) reply to the questionnaire (Fig. 1). Just over half of those who answered considered SDB in clinical practice. Most of those who answered thought that SDB was relevant or very relevant problem. Just under half of PUs reported that parents were informed on SDB condition but only a minority reported that parents knew of potential serious complications of SDB. Most respondents made SDB diagnosis using both clinical and instrumental tools. Just under half managed SDB used pharmacological treatment, half suggested adenoidectomy, much less than half suggested adenotonsillectomy, half recommended weight loss and just under half never suggested non-invasive ventilation (NIV). Regarding instrumental tools, much more than half of the PUs performed night pulse oximetry, just under half used polygraphy with EEG and just under a quarter used full polysomnography (PSG) (Table 1). Regarding satisfaction, half of those who answered were satisfied about SDB management. Operator satisfaction correlated with the availability of instrumental diagnosis.

Differences among Northern, Central and Southern Italy are reported in Table 2. Pediatricians of Northern Italy much more than half thought that much less than half parents were informed about SDB than pediatrician living in Central and Southern Italy (just over half). A clinical and instrumental diagnosis was performed much more than half by Pediatricians of Northern and in all Central Italy than pediatricians living in Southern of Italy (just over half). Other differences between the geographical areas regarded treatments. In particular, drugs were frequently proposed in both Central and Southern (just over half) than in Northern Italy (much less than half). Adenotonsillectomy is more frequently proposed by pediatricians living at Central Italy (much more than half) and North Italy (just under half). No differences in satisfaction were observed between geographical areas.

Differences between satisfied and not satisfied pediatricians are reported in Table 3. Satisfied pediatricians considered SDB much more than half in their clinical practice than not satisfied. Satisfied pediatricians thought that a quarter of parents of children with SDB better know the serious complications from untreated SDB than not satisfied. Satisfied were able to diagnose SDB using both clinical and instrumental diagnosis (much more than half) than not-satisfied (half). No differences in management of children with SDB were found. Satisfied pediatricians performed night pulse oximetry (much more than half), poligraphy with EEG (much more than half) and full polysomnography (much less than half) than not satisfied.