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Identification of hypoxaemia in children having tonsillectomy and adenoidectomy
V H Van Someren1, J Hibbert, J K Stothers
1Department of Paediatrics, United Medical School, Guy's Hospital, London.
Insights
Children undergoing tonsillectomy and adenoidectomy often experience sleep hypoxemia. Simple clinical signs like mouth breathing and awake oxygen saturation can help screen for this condition.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Physiology
Background:
- Sleep-disordered breathing, including hypoxemia, is a concern in children undergoing tonsillectomy and adenoidectomy.
- Predicting hypoxemia based on clinical signs and symptoms is crucial for timely intervention.
Purpose of the Study:
- To investigate sleep hypoxemia in children before tonsillectomy and adenoidectomy.
- To evaluate the predictive value of clinical signs and symptoms for sleep hypoxemia.
Main Methods:
- Studied 44 children before surgery and 20 controls using pulse oximetry for awake and asleep oxygen saturation (SaO2).
- Continuous monitoring of ECG and chest impedance during sleep.
- Defined significant hypoxemia as baseline sleeping SaO2 <90% or frequent dips in SaO2.
Main Results:
- Children awaiting surgery showed significantly higher measures of hypoxemia compared to controls (P<0.01).
- 15 children had abnormal sleep studies indicating significant hypoxemia.
- A combination of mouth breathing, audible respiration, and awake SaO2 <96% identified 93% of affected children.
Conclusions:
- Clinical assessment including mouth breathing and awake oxygen saturation measurement can serve as a useful screening tool.
- This approach aids in identifying children potentially suffering from sleep apnea before surgery.
Abstract:
A series of children having tonsillectomy and adenoidectomy was investigated for hypoxaemia during sleep and to assess the value of signs and symptoms as predictors of hypoxaemia. Forty-four children were studied the night before surgery. Oxygen saturation (SaO2) was measured whilst the child was awake using a pulse oximeter and when the child was asleep oxygen saturation. ECG and chest impedance were continuously monitored and recorded. In addition, 20 control children having urological surgery were studied in the same way. All the measures of hypoxaemia (awake SaO2, baseline asleep SaO2, number of hypoxaemic episodes) differed significantly between patients and controls (P less than 0.01). When significant hypoxaemia was defined as a baseline sleeping SaO2 below 90% or one dip in SaO2 of at least 10% below the baseline per hour 15 children were found to have abnormal studies. These children could not be identified from history or clinical examination but using the criteria of mouth breathing, audible respiration at rest and an awake SaO2 of less than 96%, 14 of the 15 children were accurately identified (93% sensitivity, 86% specificity). Thus a combination of the physical signs of mouth breathing and measurement of oxygen saturation whilst awake may provide a useful clinic screening test for children suspected of suffering from sleep apnoea.