Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Polysomnography for sleep-disordered breathing prior to tonsillectomy in children

15.06.2011
A multidisciplinary clinical practice guideline, "Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children" will be published as a supplement to the July issue of Otolaryngology—Head and Neck Surgery.

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 newsroom@entnet.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 like getting an EKG but while asleep: children stay overnight, with their parent, in a special sleep lab with stick-on electrodes that record oxygen levels, respiratory effort, heart rate, and other factors.

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.
Sleep-disordered breathing affects 12% of children and is the #1 reason why over 530,000 tonsillectomies are performed annually on children under age 15 years in the United States.

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.
Although the guideline was developed with other specialties, the intent is to provide guidance for ENT (ear, nose, and throat) doctors, also called otolaryngologists – head and neck surgeons.

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).
Doctors should encourage otherwise healthy children (without any of the conditions in #1) to have PSG when either the need for tonsillectomy is uncertain (e.g., differing opinions or observations among parents, family members, primary care doctors, and specialists) or when size of the tonsils is smaller than what would be expected from the severity of snoring or sleep disturbance.
When a child does get PSG before tonsillectomy, the surgeon should communicate the test results to the anesthesiologist before surgery begins in case the anesthesia approach needs to be modified.
Children should be admitted to the hospital for overnight monitoring after tonsillectomy if they are under 3 years of age, because they may require oxygen or breathing assistance after surgery.
Children should be admitted to the hospital for overnight monitoring after tonsillectomy if PSG indicates they have severe obstructive sleep apnea, which is a type of sleep-disordered breathing in which the child's oxygen levels drop below 80%, there are 10 or more breathing obstructions (weak breaths or apneas lasting 10 seconds or longer) every hour, or both.

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!
Further information:
http://www.entnet.org

More articles from Health and Medicine:

nachricht New antibody analysis accelerates rational vaccine design
09.08.2018 | Scripps Research Institute

nachricht Distrust of power influences choice of medical procedures
01.08.2018 | Johannes Gutenberg-Universität Mainz

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New interactive machine learning tool makes car designs more aerodynamic

Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.

When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...

Im Focus: Robots as 'pump attendants': TU Graz develops robot-controlled rapid charging system for e-vehicles

Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.

Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....

Im Focus: The “TRiC” to folding actin

Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.

Actin is the most abundant protein in highly developed cells and has diverse functions in processes like cell stabilization, cell division and muscle...

Im Focus: Lining up surprising behaviors of superconductor with one of the world's strongest magnets

Scientists have discovered that the electrical resistance of a copper-oxide compound depends on the magnetic field in a very unusual way -- a finding that could help direct the search for materials that can perfectly conduct electricity at room temperatur

What happens when really powerful magnets--capable of producing magnetic fields nearly two million times stronger than Earth's--are applied to materials that...

Im Focus: World record: Fastest 3-D tomographic images at BESSY II

The quality of materials often depends on the manufacturing process. In casting and welding, for example, the rate at which melts solidify and the resulting microstructure of the alloy is important. With metallic foams as well, it depends on exactly how the foaming process takes place. To understand these processes fully requires fast sensing capability. The fastest 3D tomographic images to date have now been achieved at the BESSY II X-ray source operated by the Helmholtz-Zentrum Berlin.

Dr. Francisco Garcia-Moreno and his team have designed a turntable that rotates ultra-stably about its axis at a constant rotational speed. This really depends...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Within reach of the Universe

08.08.2018 | Event News

A journey through the history of microscopy – new exhibition opens at the MDC

27.07.2018 | Event News

2018 Work Research Conference

25.07.2018 | Event News

 
Latest News

'Building up' stretchable electronics to be as multipurpose as your smartphone

14.08.2018 | Information Technology

During HIV infection, antibody can block B cells from fighting pathogens

14.08.2018 | Life Sciences

First study on physical properties of giant cancer cells may inform new treatments

14.08.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>