Age criteria for polysomnography and inpatient management for adenotonsillectomy

Area of Science:

• Pediatric Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Current clinical practice guidelines recommend preoperative polysomnography (PSG) for children under two years old with sleep disordered breathing (SDB).
• Guidelines also recommend inpatient admission for children under three years old after adenotonsillectomy (TA).
• An inconsistency exists in age recommendations for PSG and inpatient management, as the underlying rationale is similar.

Purpose of the Study:

• To compare the characteristics of patients under two years old versus those aged two to three years old undergoing workup and treatment for SDB.
• To evaluate if children aged two to three years old should be managed similarly to those under two years old regarding SDB treatment and preoperative PSG.

Main Methods:

• Retrospective case series review of patients under three years old who underwent PSG between 2015 and 2019.
• Bivariate analysis using Pearson chi-square test and multivariate analysis using multinomial logistic regression were performed.
• 427 patients were included, with 217 in the under two years old group and 210 in the two to three years old group.

Main Results:

• Severity of obstructive sleep apnea (OSA) was similar between the two age groups (p=0.069).
• Surgical outcomes, including OSA resolution on follow-up PSG, were also similar (p=0.260).
• Children under two years old were more likely to have smaller tonsils compared to those aged two to three years old (p<0.024).

Conclusions:

• Key characteristics, including OSA severity, are comparable between children under two and those aged two to three years old.
• Further research is warranted to determine if routine preoperative PSG should be considered for all children under three years old with SDB.
• The findings suggest a potential need to revise current age-based recommendations for SDB management.