Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsiilectomy in Children

摘要

Objective. This guideline provides otolaryngoiogists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and are candidates for tonsiilectomy, 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 tonsiilectomy, 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: (I) before determining the need for tonsiilectomy, 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, neu-romuscular disorders, sickle cell disease, or mucopolysacchari-doses. (2) The clinician should advocate for polysomnography prior to tonsiilectomy for sleep-disordered breathing in children without any of the comorbidities listed in statement I 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 tonsiilectomy in a child with sleep-disordered breathing. (4) Clinicians should admit children with obstructive sleep apnea documented on polysomnography for inpa...