Age criteria for polysomnography and inpatient management for adenotonsillectomy

Abstract

ObjectiveClinical practice guidelines (CPG) by the American Academy of Otolaryngology recommend that children <2yo with sleep disordered breathing (SDB) undergo preoperative polysomnography (PSG) and children <3yo be admitted following adenotonsillectomy (TA) for inpatient management. As the rationale for preoperative PSG and postoperative admission in the CPG are the same, there is an inconsistency in the age recommendations between <2yo and two to three-years-old (2-3yo). This study compared the characteristics of <2yo versus 2-3yo patients undergoing workup and treatment for SDB, with the goal of determining whether 2-3yo should be classified with <2yo. Study designCase series with retrospective review. SettingBoston Medical Center, a tertiary academic hospital. MethodsPatients ≤3yo who underwent PSG 2015 to 2019 were identified using a filter through the electronic medical record. 448 patients underwent PSG. Bivariate analysis via Pearson chi-square test and multivariate analysis via multinomial logistic regression were performed using SPSS. ResultsOf the 427 patients included in this study, 217 patients were in the age group of <2yo while 210 patients were in the age group of 2-3yo. Severity of OSA (p = 0.069) and surgical outcomes (defined by presence or resolution of OSA on follow-up PSG) (p = 0.260) were similar between the two groups. Children <2yo were more likely to have smaller tonsils (p < 0.024) than 2-3yo. ConclusionCharacteristics, such as severity of OSA, were similar between the age groups. Further studies should be conducted to determine if consideration should be taken for routine preoperative PSG children <3yo.Level of evidence: IV.