Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children

@article{Roland2011ClinicalPG,
  title={Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children},
  author={Peter Sargent Roland and Richard M. Rosenfeld and Lee J. Brooks and Norman R Friedman and Jacqueline E. Jones and Tae W. Kim and Siobhan Kuhar and Ron B. Mitchell and Michael D. Seidman and Stephen H. Sheldon and Stephanie L. Jones and Peter J. Robertson},
  journal={Otolaryngology–Head and Neck Surgery},
  year={2011},
  volume={145},
  pages={S1 - S15}
}
Objective. This guideline provides otolaryngologists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and are candidates for tonsillectomy, with or without adenoidectomy. Polysomnography is the electrographic recording of simultaneous physiologic variables during sleep and is currently considered the gold standard for objectively assessing sleep disorders. Purpose. There is no current consensus or guideline… 

Tables from this paper

Predictors of Obtaining Polysomnography Among Otolaryngologists Prior to Adenotonsillectomy for Childhood Sleep-Disordered Breathing.

TLDR
Among children who underwent AT, the only significant predictor of obtaining pre-AT PSG was age 1 to 3 years, and the rate of adherence to the AAO-HNS guideline recommendations was low, which represents an educational opportunity.

Impact of AAO-HNS Guideline on Obtaining Polysomnography Prior to Tonsillectomy for Pediatric Sleep-Disordered Breathing

TLDR
There was a significant but modest increase in pre-AT PSG utilization in children with SDB and high-risk comorbidities at this institution, consistent with AAO-HNS guideline recommendations, however, overall guideline adherence remains low and may reflect limitations in PSG testing capacity.

Polysomnography in Pediatric Otolaryngology: If Not Obstructive Sleep Apnea, What Is It?

TLDR
While OSA and snoring were the most common diagnoses reported, PLMS, alveolar hypoventilation, and CSA occurred in 7.4%, 6.8%, and 5.4% of children undergoing PSG, indicating that additional diagnoses other than OSA should be considered for children seen in an otolaryngology clinic setting.

Accuracy of Parental Perception of Nighttime Breathing in Children with Down Syndrome

TLDR
Assessment of parents’ accuracy of their children’s breathing patterns as compared with PSGs in a larger cohort of children with DS found parents are unable to predict the presence or absence of OSA by nighttime symptoms, nor are they able to determine its severity.

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

TLDR
This practice guideline focuses on uncomplicated childhood OSAS, that is, OSAS associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy child who is being treated in the primary care setting.

Pediatric polysomnography for sleep-disordered breathing prior to tonsillectomy: a guideline review.

TLDR
The management of SDB in pediatric patients relies on the accurate assessment of symptoms ofSDB, identification of comorbidities known to increase the severity of SDBs, and appropriate preoperative assessment of the patient.

Polysomnography before Tonsillectomy in Children

  • D. Tunkel
  • Medicine, Psychology
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2012
TLDR
An evidence-based clinical practice guideline on the use of PSG in children before adenotonsillectomy has recently been published, emphasizing the appropriate indications for PSG as well as the limitations of existing evidence.

Pediatric obstructive sleep apnea - evaluation of questionnaire and surgical treatment

TLDR
A randomized study investigated whether tonsillotomy is as effective as tonsillectomy in treating OSA, and demonstrated substantial shifts in the trends of tonsil surgery over the period, with an overall increase in incidence oftonsil procedures.
...

References

SHOWING 1-10 OF 104 REFERENCES

Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome.

TLDR
This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OSAS, but is designed to assist primary care clinicians by providing a framework for diagnostic decision-making.

Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome.

TLDR
This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OSAS, but is designed to assist primary care clinicians by providing a framework for diagnostic decisionmaking.

Evaluation of obstructive sleep apnea by polysomnography prior to pediatric adenotonsillectomy.

  • A. Messner
  • Medicine
    Archives of otolaryngology--head & neck surgery
  • 1999
TLDR
Whether every child with the symptoms and signs of a sleep-related breathing disorder should undergo Polysomnography to confirm the diagnosis of OSAS prior to T&A is examined.

Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy

TLDR
It is concluded that home testing, using a simplified cardiorespiratory montage plus video recording, is accurate and of practical use in the routine evaluation of OSAS in patients with adenotonsillar hypertrophy.

Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy

TLDR
Polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness, suggesting the need for better measures or improved understanding of underlying causal mechanisms.

Adenotonsillectomy for treatment of obstructive sleep apnea in children.

TLDR
All patients improved with adenotonsillectomy, but patients with the most severe RDI often had many respiratory events after surgery, and history and physical findings were not useful in predicting outcome.

Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine.

  • N. CollopW. Anderson R. Schwab
  • Medicine
    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
  • 2007
TLDR
PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures and must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist.

Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated?

TLDR
Nasal continuous positive airway pressure (CPAP) and bilevel CPAP was used successfully to manage the preoperative and/or postoperative upper airway obstruction in five children with obstructive sleep apnea syndrome and overnight observation with an apnea monitor and oximeter is recommended.
...