Pediatric Obstructive Sleep‐Disordered Breathing: Updated Polysomnography Practice Patterns

Abstract

Objective To assess the current practice patterns of pediatric otolaryngologists in managing obstructive sleep-disordered breathing 6 years following the 2011 publication of the clinical practice guideline “Polysomnography for Sleep-Disordered Breathing prior to Tonsillectomy in Children.” Study Design Cross-sectional survey. Setting American Society of Pediatric Otolaryngology (ASPO) members. Subjects and Methods An electronic survey to assess ASPO members’ adherence to polysomnography guidelines prior to tonsillectomy. Results Forty percent (170 of 427) of ASPO members completed the survey, with 73% in academic practice and 27% in private practice. Snoring represented, on average, 48% of the respondents’ practices. The percentage of respondents who requested a polysomnogram prior to tonsillectomy ≥90% of the time was 55% (n = 94) for Down syndrome, 41% (n = 69) for a child <2 years old, and 29% (n = 49) for obese children. A total of 109 (73%) and 112 (75%) respondents admit at least 90% of the time for a child with Down syndrome and for a child <3 years of age, respectively, but only 52 (35%) have a similar practice for an obese child. Only 37% adhere to the inpatient admission recommendation for children with documented obstructive sleep apnea on polysomnogram. Conclusion The current polysomnogram practice patterns for responding pediatric otolaryngologists are not aligned with the clinical practice guideline of the American Academy of Otolaryngology—Head and Neck Surgery Foundation. The threshold for overnight observation when a preoperative polysomnogram has not been performed may be too low. A campaign is necessary to educate clinicians who take care of children with obstructive sleep-disordered breathing and to obtain more evidence to further define best practice.

Tonsillectomy for Obstructive Sleep‐Disordered Breathing: Should They Stay, or Could They Go?

“…Clinically, most children do not undergo a preoperative PSG. 10 Without a PSG, surgeons rely on clinical criteria to select children for overnight observation. Unfortunately, multiple studies have reported that clinicians are unable to predict the OSA severity by clinical criteria.…”

“…Clinically, most children do not undergo a preoperative PSG 10 . Without a PSG, surgeons rely on clinical criteria to select children for overnight observation.…”

Completion of postoperative polysomnography for children with severe obstructive sleep apnea: A quality improvement project

“…Despite recommendations by the AAO guideline for the postop monitoring of high‐risk patients with severe OSA, Friedman et al documented only 37% adherence to this recommendation based on survey results from the members of the American Society of Pediatric Otolaryngology. 14 It is also recommended that these patients should be re‐evaluated postop to determine whether further treatment is required. 4 To our knowledge, there is no study in the existing literature addressing the specific issues of postop PSG compliance.…”

Prevalence of malocclusions and oral dysfunctions in children with persistent sleep-disordered breathing after adenotonsillectomy in the long term

“…Unfortunately, PSG is a complex test, expensive, and not readily available. Given the rarity of qualified sleep laboratories to offer pediatric studies, priority is given to severe or syndromic cases, patients with obesity, or patients under 2 years of age, 50 and there can be an extended waiting period between referral and when sleep studies are done. In the examined charts, baseline SDB diagnosis prior to surgery was mostly made through clinical picture (witnessed apnea reported by parents) or oximetry.…”