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

Otolaryngology - Head and Neck Surgery - Tập 145 Số S1 - 2011
Peter S. Roland1, Richard M. Rosenfeld2, Lee J. Brooks3, Norman R. Friedman4, Jacqueline Jones5, Tae W. Kim6, Siobhan Kuhar7, Ron B. Mitchell8, Michael D. Seidman9, Stephen H. Sheldon10, Stephanie Jones11, Peter J. Robertson11
1Department of Otolaryngology–Head and Neck Surgery University of Texas Southwestern Medical School Dallas Texas USA
2Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA
3Department of Pediatrics Pulmonary Division The Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
4Children’s Sleep Medicine Laboratory The Children’s Hospital Aurora Colorado USA
5Department of Otolaryngology, New York Hospital Cornell ENT, New York, New York, USA
6Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
7Albany Regional Sleep Disorders Center, Albany ENT and Allergy Services, Albany, New York, USA
8Department of Otolaryngology Cardinal Glennon Children’s Medical Center St. Louis Missouri USA
9Department of Otolaryngology, Henry Ford Medical Center, West Bloomfield, Michigan, USA
10Sleep Medicine Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
11Department of Research and Quality Improvement American Academy of Otolaryngology–Head and Neck Surgery Alexandria Virginia USA

Tóm tắt

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 on when children 2 to 18 years of age, who are candidates for tonsillectomy, are recommended to have polysomnography. 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.Results. The committee made the following recommendations: (1) before determining the need for tonsillectomy, the clinician should refer children with sleep‐disordered breathing for polysomnography if they exhibit certain complex medical conditions such as obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses. (2) The clinician should advocate for polysomnography prior to tonsillectomy for sleep‐disordered breathing in children without any of the comorbidities listed in statement 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 sleep‐disordered breathing. (3) Clinicians should communicate polysomnography results to the anesthesiologist prior to the induction of anesthesia for tonsillectomy in a child with sleep‐disordered breathing. (4) Clinicians should admit children with obstructive sleep apnea documented on polysomnography for inpatient, overnight monitoring after tonsillectomy if they are younger than age 3 or have severe obstructive sleep apnea (apnea‐hypopnea index of 10 or more obstructive events/hour, oxygen saturation nadir less than 80%, or both). (5) In children for whom polysomnography is indicated to assess sleep‐disordered breathing prior to tonsillectomy, clinicians should obtain laboratory‐based polysomnography, when available.

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Otolaryngology - Head and Neck Surgery

Tập 145 Số S1

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