Pre-operative overnight pulse oximetry to predict high dependency unit intervention in children undergoing adenotonsillectomy for obstructive sleep apnoea

Abstract

Background: Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre. Method: A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed. Results: Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations. Conclusion: High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

Glue ear in adults, paediatric sleep apnoea and the nose in exercise

“…The paper by Sharma et al 8 . on trends in assessment and management fits in well with recent papers by Lightbody et al 9 . on pre-operative overnight oximetry as a predictor of high dependency unit requirements and the multicentre study of the T14 outcome measure in paediatric patients by Hopkins et al 10 …”

Oximetry for suspected obstructive sleep apnea-Does removal of awake data affect the result?

“…In conclusion, our study has shown that removal of periods of wakefulness at the start and end of a recording does not affect the oximetry result in the context of testing for suspected OSA, especially if the result is being assessed mainly for dips below 90% as for the McGill score . If oximetry testing is used to reduce the waiting list for polysomnography and to help otorhinolaryngology services prioritise and plan adenotonsillectomy, large numbers of tests need to be performed, and simplicity and accuracy maintained. Removal of awake data manually from oximetry recording introduces an additional time factor and potential for user error.…”

“…Overnight oximetry has a very high positive predictive value for the presence of obstructive sleep apnea (OSA) in otherwise healthy children with a good history of airway obstruction during sleep . In the face of increasing demand for polysomnography to diagnose OSA and the limited availability of this test in many settings, many sleep units are using overnight oximetry to reduce the waiting list for polysomnography and to help otorhinolaryngology services prioritise and plan adenotonsillectomy . Determination of an abnormal oximetry for this purpose is based on the frequency of dips in arterial oxygen saturation (SpO 2 ) below the thresholds of 90%, 85%, and 80%, as described in the McGill Oximetry Score .…”