Development of a pediatric obstructive sleep apnea triage algorithm
| العنوان: | Development of a pediatric obstructive sleep apnea triage algorithm |
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| المؤلفون: | Andre Isaac, Trina C. Uwiera, Hamdy El-Hakim, P. J. Mandhane, D. S. Heath, Y. Al-Rahji, C. Gerdung, Maria L. Castro-Codesal, Joanna E. MacLean, E. Eksteen |
| المصدر: | Journal of Otolaryngology-Head and Neck Surgery, Vol 50, Iss 1, Pp 1-7 (2021) Journal of Otolaryngology-Head & Neck Surgery |
| بيانات النشر: | BMC, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, RD1-811, medicine.medical_treatment, Short Report, Mouth breathing, Sleep medicine, Adenoidectomy, 03 medical and health sciences, 0302 clinical medicine, Sleep-related breathing disorder, 030225 pediatrics, medicine, Humans, Oximetry, 030223 otorhinolaryngology, Child, Tonsillectomy, Sleep Apnea, Obstructive, business.industry, Snoring, Odds ratio, medicine.disease, Triage, Obstructive sleep apnea, medicine.anatomical_structure, Otorhinolaryngology, Tonsil, Female, Surgery, medicine.symptom, business, Algorithm, Algorithms |
| الوصف: | Introduction Diagnosis and treatment of obstructive sleep apnea (OSA) in children is often delayed due to the high prevalence and limited physician and sleep testing resources. As a result, children may be referred to multiple specialties, such as pediatric sleep medicine and pediatric otolaryngology, resulting in long waitlists. Method We used data from our pediatric OSA clinic to identify predictors of tonsillectomy and/or adenoidectomy (AT). Before being seen in the clinic, parents completed the Pediatric Sleep Questionnaire (PSQ) and screening questionnaires for restless leg syndrome (RLS), nasal rhinitis, and gastroesophageal reflux disease (GERD). Tonsil size data were obtained from patient charts and graded using the Brodsky-five grade scale. Children completed an overnight oximetry study before being seen in the clinic, and a McGill oximetry score (MOS) was assigned based on the number and depth of oxygen desaturations. Logistic regression, controlling for otolaryngology physician, was used to identify significant predictors of AT. Three triage algorithms were subsequently generated based on the univariate and multivariate results to predict AT. Results From the OSA cohort, there were 469 eligible children (47% female, mean age = 8.19 years, SD = 3.59), with 89% of children reported snoring. Significant predictors of AT in univariate analysis included tonsil size and four PSQ questions, (1) struggles to breathe at night, (2) apneas, (3) daytime mouth breathing, and (4) AM dry mouth. The first triage algorithm, only using the four PSQ questions, had an odds ratio (OR) of 4.02 for predicting AT (sensitivity = 0.28, specificity = 0.91). Using only tonsil size, the second algorithm had an OR to predict AT of 9.11 (sensitivity = 0.72, specificity = 0.78). The third algorithm, where MOS was used to stratify risk for AT among those children with 2+ tonsils, had the same OR, sensitivity, and specificity as the tonsil-only algorithm. Conclusion Tonsil size was the strongest predictor of AT, while oximetry helped stratify individual risk for AT. We recommend that referral letters for snoring children include graded tonsil size to aid in the triage based on our findings. Children with 2+ tonsil sizes should be triaged to otolaryngology, while the remainder should be referred to a pediatric sleep specialist. Graphical abstract |
| اللغة: | English |
| تدمد: | 1916-0216 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0c5f73d8fade80a8387431c29cfebe12 https://doaj.org/article/1b7798466da8484b8631b7577ea472c2 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....0c5f73d8fade80a8387431c29cfebe12 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 19160216 |
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