Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns

Abstract 

Objectives: Some data suggest that the clinical diagnosis of obstructive sleep apnea (OSA) in a child should be confirmed by polysomnography before adenotonsillectomy (AT), but otolaryngology literature generally does not agree and few studies have examined surgical practice patterns.

Methods: We mailed, to 603 members of two North American otolaryngology societies, surveys about children aged 5.0–12.9 years upon whom they performed ATs in the previous year.

Results: A total of 183 otolaryngologists estimated that they had performed 24,000 ATs. Reported major surgical indications, not mutually exclusive, included recurrent throat infections (for 42% of procedures), obstructed breathing of any type (59%), OSA (39%), poor school performance (17%), and poor attention (11%). Pre-operative evaluations included an office-based, sleep-related history in 93% of children, any objective testing for OSA in <10%, and laboratory-based polysomnography in <5%. Surgeons with academic affiliations, higher volumes of ATs, and pediatric specialization reported lower percentages of ATs performed for recurrent tonsillitis as opposed to other indications.

Conclusions: As a common indication for AT, OSA now rivals recurrent throat infection. No more than 12% of school-aged children who undergo AT for OSA have polysomnography prior to the procedure. Indications for AT may depend, in part, on practice settings and otolaryngologists' backgrounds.

Keywords:  Otorhinolaryngologic diseases, Physician's practice patterns, Tonsillectomy, Sleep apnea syndromes, Sleep disorders, Polysomnography, Attention deficit disorder with hyperactivity, Child