Overnight oximetry in children undergoing adenotonsillectomy: a single center experience

Abstract

BackgroundObstructive sleep apnea (OSA) is the most common indication for adenotonsillectomy in children. Home-based sleep oximetry continues to be used in the diagnosis of pediatric OSA despite a lack of correlation with lab-based polysomnography. This study investigates whether factors influence surgeons in selecting patients for home-based sleep oximetry, how the study findings are used in patient management, and whether abnormal oximetry findings are associated with post-operative complications.MethodsA retrospective review was performed on children with suspected OSA who had undergone a tonsillectomy and/or an adenoidectomy over a three-year period. Demographic features, comorbidities, pre-operative oximetry results, and post-operative complications were recorded. Data analysis consisting primarily of logistic regression was performed using Stata 12.0 (College Station, Texas).ResultsData was collected from 389 children. Two hundred and seventy-one children underwent pre-operative oximetry (69.7%). There was no significant association between age or the presence of comorbidities and the likelihood of undergoing pre-operative sleep oximetry. The post-operative complication rate was 0.8%. There was no significant association between abnormal sleep oximetry parameters and post-operative complications. Children with one or more abnormal sleep oximetry parameters were more likely to be observed in hospital for at least one night (OR 2.4, p < 0.0001).ConclusionsOur study suggests that surgeons are using home-based sleep oximetry findings to inform the post-operative care of children with suspected OSA, as those with abnormal home-based sleep oximetry findings were more likely to be observed in hospital. These hospital admissions may be unnecessary given the poor correlation of home-based oximetry and PSG as well as the low rate of serious post-operative complications.

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

“…The mean age of our patients was 7 years, which is slightly higher than in some studies, though identical to that of other published series, such as the Childhood Adenotonsillectomy Trial (CHAT) [ 15 , 39 , 40 ]. In our opinion this was not due to selection bias, as all patients were analysed systematically, without exclusion, as part of a real-life study.…”

Development of a pediatric obstructive sleep apnea triage algorithm

“…Modifying the algorithm with information from PSG or home sleep testing rather than oximetry alone may further improve the algorithms predictive capacity. Follow-up studies may explore long-term outcomes and comparing post-operative complications [21] for patients who were triaged based on the algorithm versus a control group.…”

Alternatives to surgery in children with mild OSA

“…Since then, professional associations such as the American Academy of Pediatrics, American Academy of Sleep Medicine, American Academy of Otolaryngology-Head and Neck Surgery Foundation, European Respiratory Society, have further suggested that in the presence of characteristic OSA symptoms and some supportive physical findings, implementation of simplified testing procedures could replace the gold standard PSG in the form of home-based multichannel respiratory recordings or even single channel overnight oximetry. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 We have been among the latter, particularly based on the concern of limited access to PSG testing for children along with excessive financial costs. Development of such validated scalable diagnostic tools that can be automated would substantially reduce financial burden as well as time consuming labor involved in scoring and interpretation of polysomnograms.…”

“…Development of such validated scalable diagnostic tools that can be automated would substantially reduce financial burden as well as time consuming labor involved in scoring and interpretation of polysomnograms. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Such approaches if adopted more universally, would result not only in expedited evaluation of many children who currently are required to wait for long periods of time before being diagnosed, but would also facilitate access to pediatric sleep laboratories for those children in whom the diagnosis is uncertain, or the clinical presentation is more complex and requires more sophisticated diagnostic approaches.…”

“…Not so long ago, many of our clinical colleagues endorsed an approach that stipulated that every child who is symptomatic, e.g., habitually snores during sleep, should undergo adenotonsillectomy (AT), without requiring any diagnostic test such as a PSG. Since then, professional associations such as the American Academy of Pediatrics, American Academy of Sleep Medicine, American Academy of Otolaryngology‐Head and Neck Surgery Foundation, European Respiratory Society, have further suggested that in the presence of characteristic OSA symptoms and some supportive physical findings, implementation of simplified testing procedures could replace the gold standard PSG in the form of home‐based multichannel respiratory recordings or even single channel overnight oximetry 6–34 . We have been among the latter, particularly based on the concern of limited access to PSG testing for children along with excessive financial costs.…”