Abstract
BackgroundObstructive sleep apnea (OSA) is the most common indication for adenotonsillectomy in children. Home-based sleep oximetry continues to be used in the diagnosis of pediatric OSA despite a lack of correlation with lab-based polysomnography. This study investigates whether factors influence surgeons in selecting patients for home-based sleep oximetry, how the study findings are used in patient management, and whether abnormal oximetry findings are associated with post-operative complications.MethodsA retrospective review was performed on children with suspected OSA who had undergone a tonsillectomy and/or an adenoidectomy over a three-year period. Demographic features, comorbidities, pre-operative oximetry results, and post-operative complications were recorded. Data analysis consisting primarily of logistic regression was performed using Stata 12.0 (College Station, Texas).ResultsData was collected from 389 children. Two hundred and seventy-one children underwent pre-operative oximetry (69.7%). There was no significant association between age or the presence of comorbidities and the likelihood of undergoing pre-operative sleep oximetry. The post-operative complication rate was 0.8%. There was no significant association between abnormal sleep oximetry parameters and post-operative complications. Children with one or more abnormal sleep oximetry parameters were more likely to be observed in hospital for at least one night (OR 2.4, p < 0.0001).ConclusionsOur study suggests that surgeons are using home-based sleep oximetry findings to inform the post-operative care of children with suspected OSA, as those with abnormal home-based sleep oximetry findings were more likely to be observed in hospital. These hospital admissions may be unnecessary given the poor correlation of home-based oximetry and PSG as well as the low rate of serious post-operative complications.
Highlights
Obstructive sleep apnea (OSA) has a prevalence of up to 10% in the pediatric population [1] and can result in neurocognitive and cardiovascular sequelae [2,3,4,5]
We examined whether sleep oximetry findings affect patient management in terms of overnight admission versus day surgery
We observed no significant association between abnormal sleep oximetry parameters and postoperative complications (Table 4)
Summary
Obstructive sleep apnea (OSA) has a prevalence of up to 10% in the pediatric population [1] and can result in neurocognitive and cardiovascular sequelae [2,3,4,5]. Polysomnography (PSG) is the gold standard for diagnosing OSA [6]. Despite their diagnostic value, lab-based polysomnography can be difficult to access [7]. Lab-based overnight oximetry has been shown to have satisfactory correlation with PSG in the diagnosis of moderate to severe OSA [9]. Due to the poor agreement between home-based oximetry and PSG, the current recommendations do not support the use of this modality in the diagnosis of pediatric OSA [11]. Home-based sleep oximetry continues to be used in the diagnosis of pediatric OSA despite a lack of correlation with lab-based polysomnography. This study investigates whether factors influence surgeons in selecting patients for home-based sleep oximetry, how the study findings are used in patient management, and whether abnormal oximetry findings are associated with post-operative complications
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have