Evaluation of Obstructive Sleep Apnea by Polysomnography Prior to Pediatric Adenotonsillectomy

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Abstract
Polysomnography documenting obstructive sleep apnea should be obtained prior to tonsillectomy for airway obstruction in children with no history of infectious tonsillitis. Sleep-related breathing disorders range in disease severity from primary or simple snoring through upper airway resistance syndrome (UARS) and, at the severe end of the spectrum, obstructive sleep apnea syndrome (OSAS). Typical nighttime signs of a sleep-related breathing disorder include snoring, pauses in the breathing (apneic episodes), gasping, restless sleep, and, sometimes, enuresis. Daytime symptoms may include excessive daytime somnolence, but, in children, unlike adults, this is not a hallmark of a sleep-related breathing disorder. Some children have nonspecific behavioral difficulties, such as hyperactivity, developmental delay, rebelliousness, and aggressive behavior. In severe cases, children may grow poorly and can develop hypertrophy of the right side of the heart and cor pulmonale.