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Is a Polysomnogram Post-Tonsillectomy Worth Doing to Demonstrate Improvement in Childhood Obstructive Sleep Apnea? :

September 18, 2019

One of the leading treatments for obstructive sleep apnea (OSA) is tonsillectomy. The need for tonsillectomy is often confirmed by a polysomnogram (PSG) which is recommended in clinical guidelines from the American Academy of Otolaryngology-Head and Neck Surgery, especially for children with obesity, craniofacial disorders, Down syndrome, and other underlying medical disorders that associated with OSA.

One of the leading treatments for obstructive sleep apnea (OSA) is tonsillectomy. The need for tonsillectomy is often confirmed by a polysomnogram (PSG) which is recommended in clinical guidelines from the American Academy of Otolaryngology-Head and Neck Surgery, especially for children with obesity, craniofacial disorders, Down syndrome, and other underlying medical disorders that associated with OSA.  What is not recommended is a post-op PSG to document clinical improvement.   Is a post-op PSG predictive of improvement of OSA symptoms and long-term outcomes?  Isaiah et al. (10.1542/peds.2019-1097) evaluated the changes in 18 measured post-op outcomes of tonsillectomy to see if the improvements post-tonsillectomy were independently attributable to post-op PSG improvements. Interestingly, an improved post-op PSG only correlated with 2 of the 18 outcome measures suggesting limited utility in ordering a post-op PSG post-tonsillectomy.  It does not seem that there is much value in ordering a post-up PSG. We asked pediatric otolaryngologist Dr. Sivakumar Chinnadurai from the Children’s Hospitals and Clinics of Minnesota to weigh in with an accompanying commentary (10.1542/peds.2019-2405).  Dr. Chinnadurai helps us understand the results of this study and along with Isaiah et al. suggests other mechanisms are at work to determine improved outcomes post-tonsillectomy for children with OSA other than the PSG.  Check out both this interesting study and commentary—neither of which will put you to sleep.  We believe these articles will make you reconsider ordering the post-op PSG if you routinely do so. 

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