Current practice patterns for sleep-disordered breathing in children

Area of Science:

• Pediatric Otolaryngology
• Sleep Medicine
• Public Health

Background:

• Adenotonsillectomy is the primary treatment for pediatric sleep-disordered breathing (SDB).
• Current practice patterns among pediatric otolaryngologists for SDB management are not well-documented.
• Adherence to established clinical guidelines for SDB diagnosis and treatment is crucial for optimal patient outcomes.

Purpose of the Study:

• To survey pediatric otolaryngologists regarding their current practice patterns for managing children with SDB.
• To assess factors influencing the decision to order polysomnography (PSG) for children with SDB.
• To evaluate adherence to current guidelines for SDB diagnosis and management in pediatric populations.

Main Methods:

• A cross-sectional survey was distributed online to members of the American Society of Pediatric Otolaryngology.
• Descriptive statistics and logistic regression analysis were used to analyze survey responses.
• The study assessed the impact of practice experience, PSG wait times, and evaluation frequency on management decisions.

Main Results:

• A 39% response rate was achieved, with significant variation in PSG referral rates (4% always, 65% sometimes, 31% rarely/never).
• Increased PSG wait times predicted lower PSG referral frequency (OR = 1.10).
• Preoperative PSG was rarely mandated for children with Down syndrome (20%) or obesity (8%). Overnight observation was common for high-risk groups.

Conclusions:

• Pediatric otolaryngologists demonstrate noncompliance with established American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery guidelines for SDB.
• Despite noncompliance, there is a lower threshold for overnight monitoring of high-risk children post-surgery.
• An educational initiative is recommended to update clinicians on evidence-based guidelines for pediatric SDB management.