- 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.
Table 1. Role of PSG in Assessing High-Risk Populations Before Tonsillectomy for SDB
Role of PSG and Rationale
- Avoid unnecessary or ineffective surgery in children with primarily nonobstructive events
- Identify primarily nonobstructive events or central apnea that may not have been suspected prior to the study and may not benefit from surgery.
- Confirm the presence of obstructive events that would benefit from surgery
- The increased morbidity of surgery in high-risk children requires diagnostic certainty before proceeding.
- Define the severity of SDB to assist in preoperative planning
- Children with severely abnormal SDB may require preoperative cardiac assessment, pulmonary consultation, anesthesia evaluation, or postoperative inpatient monitoring in an intensive care setting.
- Provide a baseline PSG for comparison after surgery
- Persistent SDB or OSA despite surgery is more common in high-risk patients than in otherwise healthy children.
- Document the baseline severity of SDB
- High-risk patients are more prone to complications of surgery or anesthesia.
Table 2. Summary of Action Statements for PSG
|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.||C||R|
|The clinician should advocate for PSG prior to tonsillectomy for SDB in children without any of the comorbidities listed above 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.||C||R|
|Communication with anesthesiologist||Clinicians should communicate PSG results to the anesthesiologist prior to the induction of anesthesia for tonsillectomy in a child with SDB.||C/D||R|
|Inpatient admission for children with obstructive sleep apnea (OSA) documented in results of PSG||Clinicians should admit children with OSA documented in results of PSG for inpatient, overnight monitoring after tonsillectomy if they are younger than age 3 or have severe OSA (apnea-hypopnea index of ≥10 obstructive events/hour, oxygen saturation nadir <80%, or both).||C||R|
|Unattended PSG with portable monitoring device||In children for whom PSG is indicated to assess SDB prior to tonsillectomy, clinicians should obtain laboratory-based PSG, when available.||C||R|