According to Dr. Ishman, the implication of the guideline is that a sleep study is always an option but is not required except in a subset of patients—namely, kids at increased risk for postoperative respiratory complications (see recommendation 1 on complex medical conditions, below).
Pell Ann Wardrop, MD, an otolaryngologist and medical director of the St. Joseph Sleep Wellness Center in Lexington, Ky., agreed. “Unless the child has risk factors such as obesity, craniofacial abnormalities, or neuromuscular disease, I feel a preoperative sleep study is optional,” she said. “I do the study when there is some question or doubt if a TA is needed.” She added that if only one sleep study is done, she recommends a postoperative sleep study. “It is vital to know when residual obstructive sleep apnea is present so the child can be appropriately treated,” she added. “Some of the treatment options, such as maxillary expansion, must be performed before the child matures.”
Dr. Brietzke described the thrust of the guideline this way: “If there is a lack of consistency within a physical exam and a history, you need a sleep study,” he said. “But if there is strong clinical evidence of sleep apnea, you can proceed with TA without a sleep study.”