P2.033: Analysis of Referral Characteristics From Pediatric Cardiology to Sleep Medicine at a Tertiary Care Children's Hospital

Background: Pediatric patients with congenital heart defects and/or cardiovascular disease may be at increased risk for sleep-disordered breathing and other sleep disorders. However, the literature has not described the impact of a focused referral channel to a pediatric sleep medicine clinic from a pediatric cardiology division. This study reports an initial analysis of single institution referral patterns from a pediatric cardiology center to a sleep medicine center after creating a combined pediatric cardiology and pediatric sleep medicine provider position.

Methods: A combined pediatric cardiology (0.4 FTE) and pediatric sleep medicine (0.4 FTE) position was created at a tertiary care referral center (Ann & Robert H. Lurie Children’s Hospital, Chicago, IL) starting in the 2024-2025 academic year. New outpatient referrals and inpatient consultations from the division of pediatric cardiology to the division of sleep medicine between September 2024 through March 2025 were reviewed. Data was obtained regarding which cardiology subspecialty clinic placed the sleep medicine referral, the patient’s underlying cardiac disease, the patient’s primary sleep concern, as well as the initial sleep medicine evaluation, diagnostic study, and/or intervention.

Results: Twenty-three new clinic referrals and four inpatient consultations were placed from the pediatric cardiology division to pediatric sleep medicine. Sixteen clinic referrals (69.6%) were for sleep apnea, five (21.7%) for difficulties with sleep initiation and/or early morning awakenings, and two (8.7%) for excessive daytime sleepiness. All four inpatient consultations were for sleep apnea. Seven referrals (30.4%) originated from the preventative cardiology clinic. An additional 5 patients (21.7%) had complex single ventricle heart disease. Two referrals (8.7%) originated from the postural orthostatic tachycardia syndrome (POTS) clinic. The remainder of the referrals had non-single ventricle congenital heart disease, arrhythmia concerns, or were status-post orthotopic heart transplants. One patient was referred for sleep apnea evaluation as part of a pre-surgical evaluation. Seventy-five percent of inpatient consultations were for patients who were status-post ventricular assist device placement. Sixteen outpatient and diagnostic polysomnogram tests were ordered as part of outpatient evaluations, and three were ordered for inpatient evaluations. One patient was referred directly to otolaryngology for a drug-induced sleep endoscopy.

Conclusion: This analysis revealed substantial utilization of a referral system from a pediatric cardiology division to sleep medicine clinic. An overwhelming majority of patients had concern for sleep apnea with most patients originating from the preventative cardiology clinic or having associated complex congenital heart disease. The data suggests a potential need for ongoing multidisciplinary collaboration between pediatric cardiology and sleep medicine. Further analysis and comparison with previous referral trends prior to the creation of the combined pediatric cardiology and pediatric sleep position would be beneficial.