Management of Children Referred to ENT with Suspected Obstructive Sleep Apnea Following Overnight Oximetry

Background: Obstructive sleep apnea (OSA) has been associated with increased risk of respiratory complications after adenotonsillectomy in children. Not all such children require overnight admission, and same-day surgery is appropriate for some patients. Selection of those that are suitable for same day discharge relies on accurate identification of OSA severity. Guidelines about ‘Day Care Adenotonsillectomy in presence of Sleep Apnea’’ provided by Nottingham Children’s Hospital, the UK, published in 2014, and applies to those children who had a sleep study performed pre-operatively. A typical cost-effective practical sleep study entails at-home overnight pulse oximetry. Aim: The aim of audit study was to see if suspected OSA is appropriately managed at Trafford General Hospital (TGH), the UK, according to the standards provided by Nottingham Children’s Hospital, in addition to taking one standard from the Royal College of Pediatrics and Child Health report, on Standards for Services for Children with Disorders of Sleep Physiology, published in 2009. Study Design: This is a retrospective local audit study focused on children who were referred to ENT at TGH for suspected OSA or who were suspected of OSA during ENT follow-up for another non-OSA reason. Conclusion: There is good practice in excluding insufficiently analyzed oximetry. Non-compliance was mostly due to mild OSA being ruled in on an inconclusive study. The listing and referral for adenotonsillectomy is appropriate despite conflicting local practice to refer all children with suspected OSA to a specialized centre.