Research report
A research report is the sourced material a domain
dossier is synthesized from — generated on a plan and a cadence, one topic per file.
A report carries no confidence tags. Its bracketed markers say who might have
an incentive to shade a line; none of them says anyone checked it. To reach a score, a line has
to be drafted onto a candidate as unverified and pass the Verifier or the
Corroborator, like everything else.
Section epidemiology · Version 2026-09-01 · Cadence annual · Evidence class 2 published · Sources 8 · Supersedes none
Domain: pediatric-obstructive-sleep-apnea-testing · Scope: Public primary sources reachable by this repo's connectors, WebSearch and WebFetch, scoped to condition-level epidemiology — prevalence, incidence, trend direction, and demographic/socioeconomic concentration — for pediatric obstructive sleep apnea in the US. Excludes CPT/HCPCS-coded claims-based incidence figures (candidate-file TAM work, not condition epidemiology), any CMS or NCHS microdata requiring a local cache not present in this repo, and studies conducted entirely outside the US except where explicitly flagged as an international comparator.
Sourcing: Every quantity here rests on one source — a 2012 AAP guideline review, a 2024 preschool-specific systematic review, one national NHANES obesity-trend analysis, one national inpatient-surgery-volume trend, two independent disparity reviews, and two quantified US cohort studies; no US-specific pediatric OSA incidence rate was found by any query run this pass.
National guideline-level literature — a 2012 American Academy of Pediatrics technical report reviewing 3,166 titles and including 350 studies — puts pediatric obstructive sleep apnea syndrome (OSAS) prevalence at 0%-5.7%, naming obesity as an independent risk factor [1]. A narrower 2024 systematic review of prevalence specifically in preschool-aged children, drawing on 30 population-based studies not restricted to the US, reports questionnaire-based estimates rising from 3.3%-9.4% in studies published before 2014 to 12.8%-20.4% in studies published 2016-2023, and states this pattern "suggests that prevalence of OSA may possibly have been increasing in preschoolers over the past decade" [2]. No US-specific incidence rate — new diagnoses per unit population per year — for pediatric OSA was found by any query run this pass. Two independent, non-affiliated peer-reviewed reviews agree that pediatric sleep-disordered breathing shows ethnic, racial and socioeconomic disparities in prevalence, underdiagnosis and treatment outcomes [6][7], and a US cohort of 1,745 adolescents undergoing polysomnography found significantly higher odds of moderate-to-severe OSA in Hispanic and non-Hispanic Asian/Pacific Islander adolescents than in non-Hispanic White adolescents [5]. Converting any of the prevalence figures above into a US Census-scaled absolute count of affected children was not attempted this pass.
_Baseline (v1). No prior version; this establishes the starting point for future diffs._
The national guideline-level baseline for pediatric OSAS prevalence remains the AAP's 2012 technical report: after reviewing 3,166 titles and including 350 studies (level II-IV evidence), it states "The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor" [1] [single-source]. That figure spans the pediatric age range without an age-band breakdown and is now over a decade old.
A 2024 systematic review restricted to preschool-aged children (30 population-based studies, general population, not restricted to the US) found only seven studies confirmed OSA with an objective method after a habitual-snoring screen, and only two of those used polysomnography — testing 1.2% of the combined cohorts (n=82 of 4,575) to confirm disease, reporting prevalence of 1.8% and 6.4% depending on which apnea-hypopnea-index threshold was applied. Five further objective-method studies, covering 449 of 2,486 children (18.0%), estimated prevalence in the range 0.7%-13.0%. The remainder of the literature in that review relies on parent questionnaires alone, and among those questionnaire-only studies the review reports a shift over time: "Studies published before 2014 reported 3.3%-9.4% prevalence, while more recent studies published 2016-2023 report higher prevalence, 12.8%-20.4%, when excluding outliers. This trend suggests that prevalence of OSA may possibly have been increasing in preschoolers over the past decade." [2] [single-source]. Read narrowly: this is a preschool-specific age band (not the 5-17 population this domain evaluates), a largely non-US and heterogeneous-methods literature base, and the review's own hedge ("may possibly have been increasing") is preserved here rather than sharpened.
No source located this pass states a US-specific, multi-year trend in pediatric OSA prevalence or incidence directly. Two adjacent, quantified US trends exist. First, obesity — the one risk factor the AAP report names as independent [1] — has risen nationally: NHANES-based national data for children and adolescents aged 2-19 (n=12,104 across survey cycles) show overall obesity prevalence increasing from 17.2% (95% CI 14.9%-19.6%) in the 2013-2014 cycle to 21.1% (95% CI 18.7%-23.6%) in the August 2021-August 2023 cycle, an average annual increase of 0.44 percentage points (95% CI 0.10-0.78, P=.01), with the increase reaching significance specifically among males (+0.65 points/year, P=.003) and children aged 2-5 (+0.50 points/year, P=.01); severe obesity held stable at 7.0% (95% CI 5.8%-8.4%) [3] [single-source]. Second, a repeated cross-sectional analysis of the US Nationwide Inpatient Sample (125,691 pediatric nasal, palatal or hypopharyngeal procedures for sleep-disordered breathing or OSA, 1993-2010) found inpatient sleep-surgery volume rose from 45,671 procedures in the 1993-2000 period to 80,020 in the 2001-2010 period, with obesity recorded in a rising share of those surgical patients (4.6% to 6.7%, P<.0001) [4] [single-source]. Neither figure is itself a prevalence or incidence measure of pediatric OSA — the obesity figure is a named risk-factor's own trend, and the surgical-volume figure is a treated-volume proxy that also reflects referral patterns, surgical indication changes, and insurance coverage over an 18-year window ending in 2010.
Three separate query sets run this pass — for a claims/EHR-based incidence rate, for an administrative diagnosis-rate trend, and for a rate expressed per 1,000 children — returned no PubMed record reporting a US or population-level annual incidence rate (new diagnoses per year) for pediatric OSA specifically. This is recorded as not found, not merely not searched.
Two independent, non-affiliated peer-reviewed reviews agree that pediatric sleep-disordered breathing and OSA show ethnic, racial and socioeconomic disparities across prevalence, underdiagnosis and treatment outcomes: one summarizes "well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes" [6]; the other states that disparities in sleep-disordered breathing "reflect its overall high prevalence in children and adults from racially and ethnically minoritized or low socioeconomic status backgrounds coupled with high rates of underdiagnosis and suboptimal treatment" [7]. A quantified US clinical cohort supports the direction of that finding: a retrospective review of 1,745 adolescents undergoing diagnostic polysomnography in southern California found Hispanic adolescents (58.2% of the cohort) had a higher log-transformed obstructive apnea-hypopnea index than non-Hispanic White adolescents (24.1% of the cohort) and were 1.45 times more likely (95% CI 1.10-1.93) to have moderate-to-severe OSA (apnea-hypopnea index ≥5/hour); non-Hispanic Asian/Pacific Islander adolescents (4.3% of the cohort) were 1.81 times more likely (95% CI 1.05-3.10); in sex-stratified analysis the association with moderate-to-severe OSA held only among males [5] [single-source]. A separate single-center US retrospective chart review (n=120 children ages 3-17, all with polysomnography-proven moderate-to-severe OSA, 60 children pre-COVID-onset and 60 post-COVID-onset) found time-to-diagnosis widened, in absolute days, more for white children (42.5 to 151.9 days), high-socioeconomic-status children (38 to 146.5 days), and privately insured children (32.1 to 146.5 days) than for publicly insured children (65.7 to 105.8 days) after COVID-19 onset — a finding about a widening diagnostic-pathway gap between groups already presenting with OSA, not a prevalence or incidence figure [8] [single-source].
Converting any of the prevalence percentages above into a US Census-scaled absolute count of children aged 5-17 with OSA was not attempted in this pass: the wide AAP range (0%-5.7%) and the age-band mismatch between it and the more granular preschool-specific review [2] make that conversion unreliable without a purpose-built calculation, which belongs to a candidate file's own TAM work rather than to this report.
[1] Diagnosis and management of childhood obstructive sleep apnea syndrome — Pediatrics (published 2012, month not given in the PubMed record; accessed 2026-09-01). PMID 22926176 — https://pubmed.ncbi.nlm.nih.gov/22926176/ [peer-reviewed] [2] Prevalence of obstructive sleep apnea (OSA) among preschool aged children in the general population: A systematic review — Sleep Medicine Reviews (published 2024-02; accessed 2026-09-01). PMID 37976758 — https://pubmed.ncbi.nlm.nih.gov/37976758/ [peer-reviewed] [3] Trends in Obesity-Related Measures Among US Children, Adolescents, and Adults — JAMA (published 2025-02-13; accessed 2026-09-01). PMID 39946125 — https://pubmed.ncbi.nlm.nih.gov/39946125/ [peer-reviewed] [4] Temporal trends in inpatient pediatric sleep apnea surgery: 1993-2010 — The Laryngoscope (published 2017-05; accessed 2026-09-01). PMID 27641366 — https://pubmed.ncbi.nlm.nih.gov/27641366/ [peer-reviewed] [5] Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California — Journal of Clinical Sleep Medicine (published 2024-10-01; accessed 2026-09-01). PMID 38913342 — https://pubmed.ncbi.nlm.nih.gov/38913342/ [peer-reviewed] [6] Health disparities in pediatric sleep-disordered breathing — Paediatric Respiratory Reviews (published 2023-03; accessed 2026-09-01). PMID 35277358 — https://pubmed.ncbi.nlm.nih.gov/35277358/ [peer-reviewed] [7] Disparities in Sleep-Disordered Breathing: Upstream Risk Factors, Mechanisms, and Implications — Clinics in Chest Medicine (published 2023-09; accessed 2026-09-01). PMID 37517837 — https://pubmed.ncbi.nlm.nih.gov/37517837/ [peer-reviewed] [8] Socioeconomic determinants of moderate and severe obstructive sleep apnea in children: A pre and post COVID analysis — International Journal of Pediatric Otorhinolaryngology (published 2024-07; accessed 2026-09-01). PMID 38850596 — https://pubmed.ncbi.nlm.nih.gov/38850596/ [peer-reviewed]
Well established: Two independent, non-affiliated peer-reviewed reviews agree that pediatric sleep-disordered breathing and OSA carry ethnic, racial and socioeconomic disparities in prevalence, underdiagnosis and treatment outcomes [6][7]. Nothing else in this report reaches two independent sources stating the same quantity — every specific percentage, rate, trend coefficient or odds ratio below rests on one source and carries its own marker.
Thin: The 0%-5.7% AAP baseline prevalence rests on one 2012 guideline-literature review [1]. The preschool-specific shift from 3.3%-9.4% to 12.8%-20.4% rests on one 2024 systematic review, itself pooling heterogeneous, largely questionnaire-based studies not restricted to the US [2]. The national obesity trend rests on one JAMA/NHANES analysis [3]. The inpatient surgical-volume trend rests on one Nationwide Inpatient Sample analysis whose window ends in 2010 [4]. Both the racial/ethnic PSG-cohort odds ratios [5] and the pre/post-COVID time-to-diagnosis findings [8] rest on one US cohort study each.
Rescoped from class 3: None. Every proposition in this report is a published measured quantity — a prevalence percentage, a trend coefficient, an odds ratio, or a procedure count — reported in a citable peer-reviewed document; no question about what a person or clinician would do was posed this pass.
Out of scope: Non-US-only prevalence studies were not pursued as standalone findings, except [2], whose 30 included studies are not restricted to or broken out by country in the retrieved abstract and are flagged as such throughout. CPT- or HCPCS-coded, claims-based incidence figures were not pursued, consistent with this repo's standing treatment of CPT descriptors as AMA-licensed and out of scope for an unattended pass.
Not searched vs. not found: Not found — a US-specific annual incidence rate for pediatric OSA, searched directly across three distinct query formulations (claims/EHR-based, administrative diagnosis-rate, and per-1,000-children framings); a single source giving a US-specific, age-band-matched (5-17) prevalence trend comparable in rigor to the preschool-specific review [2]. Not searched — state-level or metropolitan-level prevalence variation; incidence or prevalence trend broken out by insurance type; any update to the AAP's 2012 prevalence review specifically (as distinct from the 2017 AASM position paper on testing modality, which the domain dossier already covers). A US Census-scaled absolute count of affected children aged 5-17 is a computation, not a search, and was not attempted here — see section 3.
[inference] The obesity trend [3] and the inpatient surgical-volume trend [4] are presented in this report only as adjacent, independently-sourced national US trends, not as evidence that pediatric OSA prevalence itself is rising — no source located this pass measures pediatric OSA prevalence longitudinally in a US population. Reading the AAP's "independent risk factor" finding [1] alongside NHANES' obesity trend [3] as circumstantial support for a rising US pediatric OSA prevalence is this report's own inference, not a stated finding of either source.
| Proposition | Evidence class | Resolvable identifier | Dossier section |
|---|---|---|---|
| The prevalence of pediatric OSAS ranged from 0% to 5.7% across 350 studies reviewed by the AAP's 2012 technical report, with obesity named as an independent risk factor | 2 published | PMID 22926176 | 1 |
| A 2024 systematic review of preschool-aged children found questionnaire-based OSA prevalence estimates of 3.3%-9.4% in studies published before 2014 versus 12.8%-20.4% in studies published 2016-2023 | 2 published | PMID 37976758 | 1 |
| US obesity prevalence among children and adolescents aged 2-19 rose from 17.2% (2013-2014) to 21.1% (August 2021-August 2023), an average annual increase of 0.44 percentage points (P=.01) | 2 published | PMID 39946125 | 1 |
| US inpatient pediatric sleep-surgery procedure volume rose from 45,671 (1993-2000) to 80,020 (2001-2010) in the Nationwide Inpatient Sample, with obesity recorded in a rising share of those patients (4.6% to 6.7%, P<.0001) | 2 published | PMID 27641366 | 1 |
| In a US cohort of 1,745 adolescents undergoing polysomnography, Hispanic and non-Hispanic Asian/Pacific Islander adolescents had significantly higher odds of moderate-to-severe OSA than non-Hispanic White adolescents (OR 1.45 and 1.81 respectively) | 2 published | PMID 38913342 | 1 |
| In a single-center US chart review, time-to-diagnosis of polysomnography-proven moderate-to-severe pediatric OSA increased more after COVID-19 onset for privately insured children (32.1 to 146.5 days) than for publicly insured children (65.7 to 105.8 days) | 2 published | PMID 38850596 | 1 |