These recommendations highlight a subpopulation of children in whom the committee felt that sleep studies are currently underutilized, according to another coauthor of the guidelines, Norman Friedman, MD, director of the Children’s Sleep Medicine Laboratory at the University of Colorado in Aurora, Colo.
Although supportive of these recommendations and the attempt by otolaryngologists to properly utilize sleep studies, Dr. Gozal emphasized that, under these guidelines, too many children will still receive suboptimal diagnosis and undergo unnecessary surgery. He said another challenge is determining the success of a surgery if the reason for the surgery is not sufficiently defined or known. Published evidence suggests that the overall cure rate of adenotonsillectomy for sleep apnea in children is much lower than previously anticipated (Otolaryngol Head Neck Surg 2008;138:265-273), he said.
But according to Pell Ann Wardrop, MD, medical director of the St. Joseph Sleep Wellness Center in Lexington, Ky., and an ENT Today editorial board member, the definition of sleep-disordered breathing in children is evolving. "It is not clear, based upon current research, that polysomnography identifies all children who have sleep-disordered breathing and will benefit from surgery," she said. "Children with snoring, and a negative standard PSG have an increased incidence of neurocognitive dysfunction and some derive benefit from adenotonsillectomy. The inclusion of nasal pressure monitoring in children, which became standard in 2007, has improved but not resolved this issue."