This guideline provides otolaryngologists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and who are candidates for tonsillectomy, with or without adenoidectomy.
Polysomnography (PSG), commonly referred to as a sleep study, is presently the gold standard for diagnosing and quantifying sleep-disordered breathing (SDB) in children. SDB affects approximately 12% of children with manifestations ranging from simple snoring to potentially serious conditions, including sleep apnea. SDB is also the most common indication for tonsillectomy with or without adenoidectomy in the United States. Since more than 530,000 tonsillectomies are performed annually on children younger than the age of 15, primarily for SDB, clear and actionable guidance on optimal use of PSG is strongly needed.
"Less than 10% of children get a sleep study before tonsillectomy," notes Richard M. Rosenfeld, MD, MPH, guideline author and consultant. "The polysomnography guideline will empower doctors and parents to get the right test for the right reasons, leading to safer surgery and better outcomes for children with tonsils that block their breathing while asleep."
The primary purpose of this guideline is to improve referral patterns for polysomnography among these patients. In creating this guideline, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of anesthesiology, pulmonology medicine, otolaryngology–head and neck surgery, pediatrics, and sleep medicine.
Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF).
The study's authors are Peter Roland, MD; Richard Rosenfeld, MD, MPH; Lee Brooks, MD; Norman Friedman, MD, DABSM; Jacqueline Jones, MD; Tae Kim, MD; Siobhan Kuhar, MD, PhD, DABSM; Ron Mitchell, MD; Michael Seidman, MD; Stephen Sheldon, DO; Stephanie Jones, and Peter Robertson, MPA.
Reporters who wish to obtain a copy of the study should contact Mary Stewart at 1-703-535-3762, or firstname.lastname@example.org.
About the AAO-HNS
The American Academy of Otolaryngology – Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents nearly 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization's vision: "Empowering otolaryngologist-head and neck surgeons to deliver the best patient care."
Important Points about the AAO-HNS Polysomnography Guideline
What is polysomnography and why is it important?Polysomnography (PSG), also called a sleep study, is the best test for diagnosing sleep-disordered breathing, which can include snoring, gasping, choking episodes, and breath-holding (apnea).
PSG is important because it helps doctors and families make evidence-based decisions about tonsillectomy and whether the surgery can be ambulatory (out-patient) or requires an overnight hospital stay.
Why is the Polysomnography Guideline newsworthy?First – and only - national, evidence-based guideline on PSG prior to tonsillectomy in children.
Treatment of sleep-disordered breathing with tonsillectomy has been shown to improve child behavior, attention span, quality of life, sleep quality, and neurocognitive functioning (classroom performance).
What is the purpose of the Polysomnography Guideline?The primary purpose of this guideline is to provide evidence-based recommendations for PSG prior to tonsillectomy in children between 2 and 18 years with sleep-disordered breathing as the reason for surgery.
Specialties that contributed to the guideline included pediatrics, sleep medicine, pediatric anesthesiology, pediatric pulmonology, and otolaryngology–head and neck surgery.
What are the newsworthy points made in the Guideline?PSG should be obtained before tonsillectomy in children with sleep-disordered breathing who have conditions that increase their risk of complications from surgery or anesthesia, including obesity, Down syndrome, craniofacial abnormalities (e.g., cleft palate), neuromuscular disorders (e.g., muscular dystrophy), sickle cell disease, or mucopolysaccharidoses (metabolic problems in digesting sugars).
When PSG is indicated to assess sleep-disordered breathing prior to tonsillectomy, doctors should obtain laboratory-based PSG (an overnight study attended by a technician in a sleep laboratory), not home-based PSG (with a portable, unattended monitoring device), because more is known about the accuracy and interpretation of laboratory-based testing.
Mary Stewart | EurekAlert!
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