Research Gaps - Polysomnography for Sleep Disordered Breathing Prior to Tonsillectomy in Children

Significant gaps in research remain regarding our knowledge about OSA and its management. The guideline committee identified several areas where future studies could improve the ability of clinicians to manage SDB patients optimally:

  1. The ability of PSG to predict the likelihood and time of onset of postoperative complications following tonsillectomy in children has yet to be determined.This is important not only for otherwise normal children but also for patients with Down syndrome,craniofacial abnormalities, neuromuscular disorders, sickle cell disease, mucopolysaccharidoses and obesity. Studies are required to determine if the risk of postoperative complications can be stratified to the patient’s disease severity as defined by PSG.
  2. Determine the degree to which overweight and/or obesity correlates with OSA severity as measured by PSG. PSG parameters that correlate with respiratory compromise perioperatively in obese children undergoing tonsillectomy should also be examined.
  3. Conduct a large-scale prospective study to determine the ability of PSG to predict surgical outcomes to determine whether abnormal PSG findings reliably predict the elimination of SDB after surgical intervention. This type of study would also be beneficial for predicting when tonsillectomy would be ineffective or potentially dangerous in the management of SDB.
  4. Develop validated severity scales for PSG to benefit inpatient hospital admission and perioperative monitoring in children with severe OSA.
  5. Examine the benefits of inpatient postoperative monitoring in children younger than age 3 with Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, mucopolysaccharidoses, or obesity where PSG identified only mild to moderate OSA.
  6. Study the impact of PSG findings (severity, including normal) on the need for additional preoperative and postoperative evaluation and testing of children with SDB compared to those without SDB. Studies are needed to determine who would benefit from postoperative PSG.
  7. Study the relationship between PSG findings (severity) and the perioperative management of children with SDB.
  8. Conduct an outcomes study to determine the optimal anesthetic management to reduce the rate of postoperative complications in light of PSG findings (severity).
  9. Study which parameters PM must measure to replicate laboratory findings and accurately predict children at risk for postoperative complications. This is of particular importance to patients who may lack access to a sleep laboratory and to those children who have difficulty sleeping in a foreign environment.
  10. Additional studies of intraoperative anesthetic parameters such as end tidal CO 2 may show promise in predicting postoperative respiratory complications in patients with SDB.