Related Experiment Video
Updated: Dec 9, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Interstate variation within a five-state health system: Polysomnography prior to tonsillectomy in trisomy 21 patients
Caroline M Kolb1, Udayan Shah2, Nicole L Aaronson2
1Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA; Department of Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
Insights
Pediatric otolaryngologists adhere to guidelines recommending polysomnography (PSG) before tonsillectomy for children with Down syndrome (DS) over 90% of the time. Further research on optimal PSG timing is needed.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Genetics
Background:
- American Academy of Otolaryngology guidelines recommend polysomnography (PSG) before tonsillectomy for children with Down syndrome (DS) since 2011.
- Sleep-disordered breathing is common in children with DS and can be exacerbated by tonsillectomy.
Purpose of the Study:
- To assess adherence to guidelines recommending PSG prior to tonsillectomy in children with DS and sleep-disordered breathing.
- Evaluate the rate of PSG utilization among pediatric otolaryngologists for this patient population.
Main Methods:
- Retrospective quality assurance review of de-identified data from four hospitals within a pediatric health system.
- Inclusion criteria: children diagnosed with DS who underwent tonsillectomy (with or without adenoidectomy) between January 1, 2018, and December 31, 2018.
- Data collected: age, sex, BMI, procedure type, and preoperative PSG status.
Main Results:
- High adherence to PSG guidelines: 90.4% (66/73) of patients with DS underwent PSG before tonsillectomy.
- Timing of PSG: 51.6% within 90 days, 92.2% within one year prior to surgery.
- Reasons for non-adherence: provider/parental concerns about patient tolerance (most common); 33% of non-PSG patients were obese or under age two.
Conclusions:
- Polysomnography prior to tonsillectomy for children with DS is achieved in over 90% of cases within this health system.
- National assessment and further studies on the optimal timing of PSG before tonsillectomy are warranted.
Objectives:
Since 2011, the American Academy of Otolaryngology - Head and Neck Surgery Clinical Practice Guidelines have recommended polysomnography (PSG) prior to tonsillectomy in children with Down syndrome (DS). The purpose of this study was to determine adherence to guidelines recommending polysomnography before tonsillectomy for children with DS and sleep-disordered breathing among pediatric otolaryngologists.
Methods:
A one-year quality assurance retrospective review was conducted at four hospitals within one pediatric health system to identify children with a diagnosis of DS who underwent a tonsillectomy with or without adenoidectomy from January 1, 2018, to December 31, 2018. De-identified data related to age, sex, BMI, procedure type, and preoperative PSG were collected and examined.
Results:
The rate of PSG prior to tonsillectomy was 90.4% (66 of 73) among patients with DS. 51.6% of PSG studies were performed within 90 days before surgery, and 92.2% (59 of 64) of PSG studies were performed within one year before surgery. 33% of patients who did not undergo PSG also were obese or under age two years. The most common reason for not obtaining a PSG prior to tonsillectomy was that either the provider or parent felt the patient would not tolerate it. There was no variance from guidelines by age, sex, and procedure type.
Conclusions:
Polysomnography for children with DS prior to tonsillectomy is achieved greater than 90% of the time in a multistate pediatric health system. Broader assessment across the nation and future studies regarding the timing of PSG before tonsillectomy are warranted.
Related Concept Videos
01:21Sleep Apnea
The condition is more prevalent among...
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.