Introduction The burden of racial disparities in diagnosis and treatment of Obstructive sleep apnea (OSA) remains underrecognized among the Native American population. This study intends to assess the knowledge and attitudes towards diagnosis and management of obstructive sleep apnea among the primary care physicians caring for the Native American population. Methods A cross-sectional survey was conducted at an Indian Health Services (IHS) primary care clinic. A validated OSA Knowledge (18 questions) and Attitudes (5 questions) (OSAKA) questionnaire was used, in addition to one question to address referrals to a sleep specialist. Results A total of 20 primary care providers were invited to participate in the survey with a response rate of 45% (9 participants, 2 males and 7 females). The median (IQR) knowledge score was 14 (13-16). The mean (±SD) percentage of correct response (proportion of correctly answered questions) was 79% (±9.5), which was similar to previously reported scores among primary care physicians in other studies. There was no significant knowledge difference between males and females and no difference based on age. All participants felt it was very or extremely important to identify patients with OSA and that OSA is important as a clinical disorder. There was a significant positive correlation between knowledge and recognizing the importance of OSA as clinical disorder, and between knowledge and confidence in identification of OSA. There was a negative correlation between confidence in OSA identification and referral to a sleep specialist but was not statistically significant. Only one participant (11%) felt comfortable managing patients on CPAP therapy, but there was no significant correlation with referrals to a sleep specialist. Conclusion Obstructive sleep apnea knowledge in IHS primary care providers is comparable to their peers. However, the lack of comfort in managing patients with OSA on CPAP did not increase referrals to a sleep specialist. This highlights a possible disparity and resource gap in treating Native Americans within the IHS health system with sleep apnea and further studies are needed. Support (If Any)

Introduction Obstructive Sleep Apnea (OSA) has many impacts on homeostasis. In pediatrics, there have been links observed between health problems and OSA including failure to thrive, obesity, and behavioral disorders. Existing literature evaluates the links between excess weight, obesity, and OSA. However, there is a lack of research exploring the association between OSA and reduced appetite as a contributor to failure to thrive in the pediatric population. In this study, we hypothesized there is a positive correlation between OSA severity and the presence of poor appetite. Methods We analyzed data retrospectively through medical records of 155 pediatric patients (age < 18 years old) who were diagnosed with OSA by pediatric criteria via polysomnography from April through November 2021. Data was collected from a pre-completed questionnaire done by the guardian or child during the sleep study intake. Poor appetite symptoms were ranked on a Likert scale of occurring “never”, “rarely”, “occasionally”, “frequently”, “regularly”, or “don’t know.” The presence of poor appetite symptoms was compared to the severity of pediatric OSA diagnosed during the sleep study. Pearson chi-squared test and Spearman’s correlation coefficient were calculated on the data sets. Results Of 155 patients, 33 (21.3%) were diagnosed with mild OSA, 70 (45.2%) with moderate OSA, and 52 (33.5%) with severe OSA based on pediatric criteria. A total of 53 patients reported poor appetite occasionally, frequently, or regularly. 29.4% of patients with mild OSA reported poor appetite, along with 45.7% of patients with moderate OSA, and 21.2% of patients with severe OSA. Of all patients who reported poor appetite, 60.3% had moderate OSA. However, there was a non-statistically significant correlation between apnea hypopnea index (AHI) and the presence of poor appetite symptoms, Spearman's correlation coefficient of -0.1044 (p-value 0.1960). Conclusion Overall our data did not show a significant correlation between OSA severity and poor appetite symptoms. There was an association between poor appetite and moderate OSA, however this data is limited by selection bias as 45.2% of patients were categorized as moderate OSA. Further studies are needed, including analyses with similar size populations of each OSA severity category. Support (If Any)