Use of Polysomnography and CPAP in Children Who Received Adenotonsillectomy, US 2004 to 2018

Abstract

Objectives: 1) To determine the prevalence polysomnogram (PSG) and continuous positive airway pressure (CPAP) therapy use in children who received adenotonsillectomy (AT) for sleep symptoms. 2) To identify health care disparities in these regards.Study Design: Retrospective database analysis.Methods: This study used data from Optum (Health Services Innovation Company) to identify 92,490 children who received AT for sleep symptoms between 2004 and 2018. Prevalence of preoperative PSG and postoperative PSG and CPAP were described. Clinical and demographic characteristics were compared between children who had preoperative PSG and those who did not. Characteristics of children with trisomy 21 (T21) were compared to assess PSG and CPAP use in a high-risk cohort. Predictive modeling was used to identify patient characteristics associated with postoperative PSG and CPAP use.Results: Preoperative PSG was obtained in 5.5% of children overall and 33.2% of children with T21. Male sex, obesity, other medical comorbidities, non-White race/ethnicity, and higher parent education were associated with preoperative PSG. Fewer than 3% of children received postoperative PSGs and approximately 3% went on to receive CPAP therapy postoperatively. Multiple logistic regression showed that age at surgery, male sex, obesity, other medical comorbidities, non-White race/ ethnicity, and higher parent education were associated with postoperative PSG and CPAP use.Conclusions and Relevance: This study described the prevalence pre-AT PSG use and post-AT PSG and CPAP use for persistent symptoms and identified sleep health care disparities in these regards. These results show that increased, equitable access to PSG is needed in children, particularly in the workup and treatment persistent symptoms after AT.

Pediatric pulmonology year in review 2022: Sleep medicine

“…In a high‐risk cohort of children with Down Syndrome, only 33% received a preoperative PSG. Of those who had preoperative PSG, only 1% received a postoperative PSG, but 3% went on to receive CPAP 60 …”

“…59 In addition, patients undergoing a repeat PSG were more likely to undergo another sleep-related intervention, including DISE, lingual tonsillectomy, and inferior turbinate reduction. 58 Quan et al 60 found that pediatric PSG was underused nationally, with only 5% of children having preoperative PSG. Factors such as male sex, obesity, medical comorbidities, non-White race/ethnicity, and higher parental education were associated with receiving PSG.…”

“…Of those who had preoperative PSG, only 1% received a postoperative PSG, but 3% went on to receive CPAP. 60 Two recent studies investigated the use of positive airway pressure (PAP) therapy in children with obstructive sleep apnea (OSA) and the need for repeat titration studies. Yendur et al 61 conducted a retrospective review of 64 children, finding no significant difference in PSG parameters or recommended PAP pressure changes between two separate titration studies conducted within a 2-year period after initiation of PAP therapy.…”

Average Volume-assured Pressure Support as Rescue Therapy after CPAP Failure in Pediatric Obstructive Sleep Apnea: A Retrospective Case Series Study

“…However, the prevalence of persistent OSA following adenotonsillectomy in children is as high as 25-40% [ 1 , 11 ]. Continuous positive airway pressure (CPAP) therapy is recommended for the management of residual OSA following adenotonsillectomy [ 2 , 12 ]. However, CPAP titration may fail due to multiple reasons, including persistent OSA despite CPAP, persistent hypoventilation despite CPAP, treatment-emergent central sleep apnea, and patient intolerance to CPAP therapy [ 13 - 17 ].…”