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Published on: December 6, 2016
Utility of screening questionnaire and polysomnography to predict postoperative outcomes in children
Hiromi Kako1, Jennifer Tripi2, Hina Walia3
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, USA.
Insights
A brief questionnaire can help predict the need for oxygen in children undergoing surgery. This tool aids in identifying pediatric obstructive sleep apnea (OSA) risks before procedures.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Surgical Outcomes Research
Background:
- Pediatric obstructive sleep apnea (OSA) prevalence is rising with obesity.
- A validated questionnaire previously predicted OSA on polysomnography (PSG).
- This study evaluated the questionnaire's ability to predict postoperative outcomes.
Purpose of the Study:
- To assess the predictive utility of a short OSA questionnaire for postoperative outcomes in children.
- To compare questionnaire-based prediction with PSG-diagnosed OSA for surgical outcomes.
Main Methods:
- Children undergoing surgery completed a prospective OSA screening questionnaire.
- Questionnaire scores were analyzed against postoperative outcomes like PACU length of stay and oxygen requirement.
- Procedures were included if performed within 1 year of PSG.
Main Results:
- The questionnaire identified 122/185 children as likely to have OSA (89% sensitivity, 41% specificity).
- Supplemental oxygen use in the PACU was associated with both a high questionnaire score (≥2/6) and a PSG diagnosis of OSA.
- Neither OSA diagnosis nor questionnaire score predicted prolonged PACU length of stay.
Conclusions:
- The questionnaire demonstrates comparable predictive value to PSG for predicting oxygen use in the PACU.
- A brief questionnaire can be useful for preoperative risk stratification in children with suspected OSA.
- Further research is needed to determine the questionnaire's utility for predicting rarer adverse events.
Introduction:
The prevalence of pediatric obstructive sleep apnea (OSA) has increased concurrently with the increasing prevalence of obesity. We have previously validated a short questionnaire predicting the occurrence of OSA on polysomnography (PSG). This follow-up study assessed the utility of the questionnaire in predicting postoperative outcomes.
Methods:
Children undergoing surgery and completing a sleep study were prospectively screened for OSA using a short questionnaire. Procedures within 1 year of PSG were included in the analysis. Questionnaires were scored according to a cutoff previously deemed optimal for predicting OSA (apnea-hypopnea index ≥ 5) on the sleep study. Postoperative outcomes included prolonged (>60 min) length of stay (LOS) in the post-anesthesia care unit (PACU) and oxygen requirement in the PACU.
Results:
The study cohort included 185 patients (100/85 male/female) age 8 ± 4 years, undergoing adenotonsillectomy (n = 109), other ear, nose, and throat (ENT) procedures (n = 18), or non-ENT procedures (n = 58). There were 45 patients with OSA documented by PSG and 122 patients identified as likely to have OSA according to questionnaire responses (89% sensitivity, 41% specificity). PACU LOS was prolonged in 55/181 (30%) cases and supplemental oxygen was used in the PACU in 29/181 (16%) cases. In separate multivariable models, supplemental oxygen use in the PACU was more common if a patient scored ≥2/6 points on the short questionnaire scale (OR = 5.0; 95% CI: 1.3, 19.9; p = 0.023) or if the patient was diagnosed with OSA on PSG (OR = 4.6; 95% CI: 1.6, 13.5; p = 0.005). Neither OSA on PSG nor questionnaire score ≥2/6 were associated with prolonged PACU stay.
Conclusion:
Both OSA diagnosis based on the AHI and the questionnaire scale achieved comparable predictive value for the need for oxygen use in the PACU. The utility of the questionnaire in predicting rare adverse events (e.g., unplanned admission or rapid response team activation) remains to be determined. Our preliminary results support using a brief questionnaire scale for preoperative risk stratification among children with suspected OSA who have not had a formal sleep study.
