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Published on: December 6, 2016
Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery
Stacey L Ishman1,2,3, Kareem O Tawfik3, David F Smith1
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Anesthesia providers rarely screen for obstructive sleep apnea (OSA) in children undergoing ambulatory surgery. Snoring was the most common symptom identified, yet children most needing screening for OSA were least likely to receive it.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Sleep Medicine
Background:
- Guidelines recommend screening for obstructive sleep apnea (OSA) in patients undergoing ambulatory surgery.
- OSA poses risks, particularly in pediatric surgical patients.
Purpose of the Study:
- To evaluate the frequency of OSA screening by anesthesia providers in children undergoing ambulatory surgery.
- To identify symptoms and patient characteristics associated with OSA screening.
Main Methods:
- Prospective, single-blinded observational study.
- Anesthesia providers interviewed caregivers of pediatric patients scheduled for ambulatory surgery.
- Data collected on patient demographics, OSA symptoms, and screening practices.
Main Results:
- Only 31% of 101 pediatric patients were screened for OSA.
- Snoring was the most frequently recorded symptom (28%).
- Screened patients were more likely to report snoring, have diagnosed OSA, or be scheduled for adenotonsillectomy.
Conclusions:
- Routine OSA screening by anesthesia providers is lacking in pediatric ambulatory surgery.
- "Snoring" was the most common symptom noted during screening.
- Children who could benefit most from OSA screening were paradoxically least likely to be screened.
Purpose:
The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting.
Methods:
Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery.
Results:
One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p < 0.001), known OSA (p = 0.006), and a scheduled adenotonsillectomy (p = 0.02).
Conclusion:
OSA was not routinely screened for by anesthesia providers prior to ambulatory pediatric surgery. When screening did occur, "snoring" was the most commonly recorded symptom. Paradoxically, patients with undiagnosed OSA who would benefit the most from screening were the least likely to be screened.
Commentary:
A commentary on this article appears in this issue on page 697.
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