Current practice patterns for sleep-disordered breathing in children

Objectives/hypothesis: Since the primary therapy for children with sleep-disordered breathing(SDB) is adenotonsillectomy, a survey was developed to determine the current practice patterns for children with SDB by pediatric otolaryngologists.

Study design: Cross-sectional survey

Methods: An Internet-based survey was sent to all American Society of Pediatric Otolaryngology members. In addition to descriptive statistics, a logistic regression was performed to assess if years in practice, polysomnogram (PSG) wait time, or frequency of evaluating snoring children changes management.

Results: The response rate was 39% (135/345). Children with SDB were "most of the time" referred for PSGs by 4% of respondents. Sixty-five percent referred for PSG "sometimes," and 31% referred "rarely" or "never." An increased wait time was a significant predictor of PSG frequency (OR = 1.10, 95% CI: 0.92-1.0, P = 0.039). Children with Down syndrome or obesity had preoperative PSG requested "always" 20% and 8% of the time. The primary reason for requesting a PSG in a normal child was inconsistent clinical evaluation (58%). To diagnose obesity, most (72%) record height and weight, but only 34% record BMI% for age. Overnight observation was performed "most of the time" for the following groups: Obese (70%), Down syndrome (83%), and <3 years (83%).

Conclusions: Pediatric otolaryngologists are noncompliant with the 2002 American Academy of Pediatrics and the 2011 American Academy of Otolaryngology-Head and Neck Surgery guidelines. Despite noncompliance, they fortunately have a lower threshold to monitor high-risk children overnight following surgery. The recommended Center for Disease Control measures to diagnose childhood obesity occasionally are being utilized. An educational campaign is necessary to update clinicians who take care of children on the new evidence-based guidelines.