When an ‘elective’ sleep study is done before adenotonsillectomy, it turns out that 44.7% of children suspected of OSA have an apnea-hypopnea index of less than 2, a new study reports.

There are conflicting guidelines on the potential benefit of sleep studies (polysomnography) on children who are suspected of having obstructive sleep apnea. Often doctors suggest adenotonsillectomy (removal of both the adenoids and tonsils) without recommending a sleep study first.

But when researchers performed a retrospective study on patients aged two to 18 who underwent diagnostic polysomnography for sleep-disordered breathing between 2012 and 2018, their results found that many actually had normal sleep studies (defined as an apnea-hypopnea index of less than 2).

“We found that many children (44.7%) who would theoretically proceed to surgery without a preoperative sleep study if the guidelines were strictly followed, had normal sleep studies, potentially calling into question the need for surgery,” says corresponding author Michael Cohen, MD, assistant professor of otolaryngology-head & neck surgery at Boston University School of Medicine (BUSM), in a release.

[RELATED: Do Sleep Studies Predict Who Benefits from Adenotonsillectomy? Maybe Not]

They also found Caucasian children, children older than 4 years old, children without respiratory symptoms other than snoring, and children with smaller tonsils, were more likely to have normal sleep studies.

According to coauthor Jessica Levi, MD, associate professor of otolaryngology and pediatrics at BUSM, this research demonstrates that obtaining sleep studies can affect management decisions on whether to proceed with an adenotonsillectomy, or medically manage the child’s symptoms. “The potential delays in care and cost associated with obtaining polysomnography should be weighed against parental concerns and the possibility that the outcome could change management. These factors should be discussed with the family of each patient with a goal of shared decision-making,” says Levi, who is also director of pediatric otolaryngology at Boston Medical Center, in a release.

These findings appear online in the journal Annals of Otology, Rhinology & Laryngology.

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