A Qualitative Exploration of Clinicians' Perspectives on Obstructive Sleep Apnea Facilitators and Barriers to Care.

Background: Literature has suggested that children experience wide variation in diagnosis and treatment of obstructive sleep-disordered breathing (SDB), however, multidisciplinary perspectives on barriers and facilitators to care are not well delineated among clinicians. Methods: This qualitative study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Participants were recruited until thematic saturation was achieved across the overall dataset. Key informant interviews were conducted with physicians and advanced practice providers from primary care, otolaryngology, and sleep medicine across academic and community practices in both rural and urban settings. Interview transcripts were analyzed using a combined deductive-inductive thematic approach. Results: Sixteen clinicians participated (62.5% female, 50% private vs academic, mean years in practice 12.6 [SD 7.1]), of whom were 56% primary care providers, 31% otolaryngologists, and 13% sleep medicine specialists. Multilevel barriers to SDB care delivery were organized using the socioecological model. Among primary care providers, management of SDB varied considerably with limited use of clinical practice guidelines. Decisions to make a referral were influenced by geographic access to specialists. For clinicians with a large Spanish-speaking population, they frequently described language barriers as important obstacles that negatively affected parental interactions. Limited access to polysomnography was the most significant barrier noted by clinicians in all disciplines and led to changes in provider recommendations and clinical pathways. Conclusion: This qualitative study provides multidisciplinary clinician perspectives on barriers and facilitators to pediatric sleep-disordered breathing (SDB) care across the socioecological framework. The findings identify multilevel factors that shape care pathways and highlight actionable opportunities to improve access, including enhanced caregiver education, standardized referral practices, expanded access to polysomnography, and greater support for clinicians through evidence-based guidance and multidisciplinary collaboration.