Polysomnography before tonsillectomy in children: who and when?

The diagnosis of sleep-disordered breathing in children has centered around polysomnography (PSG). While PSG is considered the gold standard for diagnosis of obstructive sleep apnea in children, the need for PSG before adenotonsillectomy is widely debated. An evidence-based clinical practice guideline on the use of PSG in children before tonsillectomy has recently been published. The recommendations contained in this guideline are discussed, emphasizing the appropriate indications for PSG as well as the limitations of existing evidence for the use of PSG and diagnosis of sleep-disordered breathing in children.