Norman R Friedman1,2, Amanda G Ruiz1,2, Dexiang Gao3, Alexandria Jensen4, Ron B Mitchell5. 1. 1 Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA. 2. 2 Department of Otolaryngology, School of Medicine, University of Colorado, Aurora, Colorado, USA. 3. 3 Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA. 4. 4 Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora, Colorado, USA. 5. 5 Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract
OBJECTIVE: To assess the current practice patterns of pediatric otolaryngologists in managing obstructive sleep-disordered breathing 6 years following the 2011 publication of the clinical practice guideline "Polysomnography for Sleep-Disordered Breathing prior to Tonsillectomy in Children." STUDY DESIGN: Cross-sectional survey. SETTING: American Society of Pediatric Otolaryngology (ASPO) members. SUBJECTS AND METHODS: An electronic survey to assess ASPO members' adherence to polysomnography guidelines prior to tonsillectomy. RESULTS: Forty percent (170 of 427) of ASPO members completed the survey, with 73% in academic practice and 27% in private practice. Snoring represented, on average, 48% of the respondents' practices. The percentage of respondents who requested a polysomnogram prior to tonsillectomy ≥90% of the time was 55% (n = 94) for Down syndrome, 41% (n = 69) for a child <2 years old, and 29% (n = 49) for obese children. A total of 109 (73%) and 112 (75%) respondents admit at least 90% of the time for a child with Down syndrome and for a child <3 years of age, respectively, but only 52 (35%) have a similar practice for an obese child. Only 37% adhere to the inpatient admission recommendation for children with documented obstructive sleep apnea on polysomnogram. CONCLUSION: The current polysomnogram practice patterns for responding pediatric otolaryngologists are not aligned with the clinical practice guideline of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. The threshold for overnight observation when a preoperative polysomnogram has not been performed may be too low. A campaign is necessary to educate clinicians who take care of children with obstructive sleep-disordered breathing and to obtain more evidence to further define best practice.
OBJECTIVE: To assess the current practice patterns of pediatric otolaryngologists in managing obstructive sleep-disordered breathing 6 years following the 2011 publication of the clinical practice guideline "Polysomnography for Sleep-Disordered Breathing prior to Tonsillectomy in Children." STUDY DESIGN: Cross-sectional survey. SETTING: American Society of Pediatric Otolaryngology (ASPO) members. SUBJECTS AND METHODS: An electronic survey to assess ASPO members' adherence to polysomnography guidelines prior to tonsillectomy. RESULTS: Forty percent (170 of 427) of ASPO members completed the survey, with 73% in academic practice and 27% in private practice. Snoring represented, on average, 48% of the respondents' practices. The percentage of respondents who requested a polysomnogram prior to tonsillectomy ≥90% of the time was 55% (n = 94) for Down syndrome, 41% (n = 69) for a child <2 years old, and 29% (n = 49) for obesechildren. A total of 109 (73%) and 112 (75%) respondents admit at least 90% of the time for a child with Down syndrome and for a child <3 years of age, respectively, but only 52 (35%) have a similar practice for an obesechild. Only 37% adhere to the inpatient admission recommendation for children with documented obstructive sleep apnea on polysomnogram. CONCLUSION: The current polysomnogram practice patterns for responding pediatric otolaryngologists are not aligned with the clinical practice guideline of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. The threshold for overnight observation when a preoperative polysomnogram has not been performed may be too low. A campaign is necessary to educate clinicians who take care of children with obstructive sleep-disordered breathing and to obtain more evidence to further define best practice.
Entities:
Keywords:
ASPO; child; otolaryngology; polysomnography; practice guidelines as topic; sleep apnea syndromes; surveys and questionnaires; tonsillectomy