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Clinical Challenges in Otolaryngology
March 1999

Clinical Opinion: Preoperative Sleep Studies

Author Affiliations
 

H. CALHOUNKARENMDB. KUPPERSMITHRONALDMD

Arch Otolaryngol Head Neck Surg. 1999;125(3):357. doi:10.1001/archotol.125.3.357

Are there children who need tonsillectomies for reasons other than recurrent or chronic tonsillitis? I'd say the answer is "yes." Upper airway obstruction secondary to tonsillar hypertrophy can cause problematic symptoms and can be completely relieved with tonsillar excision. Is formal sleep study required before undertaking tonsillectomy for the child with obstruction but with no history of infectious pharyngitis? Dr Anna Messner answers that question with a review of the available data and concludes "no," PSG is neither necessary nor possible before tonsillectomy in all of these children. I agree with her. The fact that there is no current consensus on a PSG definition of pediatric sleep apnea underscores the difficulty in relying on sleep studies over a clinical evaluation in choosing therapy. As PSG criteria have been revised over the years, the threshold for making a laboratory diagnosis has been lowered. Many children tested in the past who did not fulfill criteria at the time would now be given unambiguous diagnoses of obstructive apnea.

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