Practice Guideline: Polysomnography Before Tonsillectomy in Children

Abstract

Program Description: The miniseminar will consist of a lively panel discussion on the evidence-based recommendations for the use of polysomnography in managing patients with sleepdisordered breathing who are candidates for tonsillectomy, with or without adenoidectomy. The panel will discuss the newly developed AAO-HNS clinical practice guideline for otolaryngologists. The primary purpose of this guideline is to improve the referral patterns for polysomnography for candidates for tonsillectomy, 2 to 18 years of age, when tonsillectomy is recommended for SDB. In creating this guideline the AAO-HNSF selected a panel representing the fields of anesthesiology, pulmonology, otolaryngology-head and neck surgery, pediatrics, and sleep medicine. The committee made recommendations that 1) Before performing tonsillectomy, the clinician should refer children with SDB for PSG if they exhibit any of the following: obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses; 2) The clinician should advocate for PSG prior to tonsillectomy for SDB in children without any of the comorbid conditions listed in statement No. 1 for whom the need for surgery is uncertain or when there is discordance between tonsillar size on physical examination and the reported severity of SDB; 3) Clinicians should communicate the results of PSG to the anesthesiologist prior to the induction of anesthesia for tonsillectomy in a child with SDB; 4) Clinicians should admit children with OSA documented on PSG for inpatient, overnight monitoring after tonsillectomy if they are under age 3 years or have severe OSA (apnea-hypopnea index of 10 or more obstructive events/hour, or have an oxygen saturation nadir less than 80%); and 5) In children for whom PSG is indicated to assess SDB prior to tonsillectomy, clinicians should obtain laboratory based PSG, when available, instead of portable monitoring (PM) with a home device. This guideline is intended to assist otolaryngologists-head and neck surgeons in making evidencebased decisions regarding PSG in children. Educational Objectives: 1) Understand when clinicians should refer children with SDB for PSG. 2) Use PSG results to identify children with SDB admitted for overnight observation following tonsillectomy. 3) Know why PSG performed in sleep laboratory is preferred over home PSG with portable monitoring devices.