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Introduction

Sleep disordered breathing (SDB) is characterized by an abnormal respiratory pattern during sleep and includes snoring, mouth breathing, and pauses in breathing. SDB encompasses a spectrum of disorders that increase in severity from primary snoring to obstructive sleep apnea (OSA). OSA is diagnosed when SDB is accompanied by an abnormal polysomnogram with obstructive events .

Pediatric Obstructive Sleep Apnea (OSA) is associated with serious cardiovascular and neuro-psychological disorders that have substantial social and economic costs. OSA has been estimated to affect about 2% of children in the United States . Night time symptoms of OSA have been well described and include snoring, witnessed apnea, restless sleep, enuresis, and frequent nightmares . Daytime symptoms include trouble concentrating, mouth breathing, morning headache, learning difficulties, emotional disturbances and daytime sleepiness . Tonsil and adenoid hypertrophy is currently recognized as the most common cause of OSA in children . Several studies have demonstrated improvement if not resolution of symptoms such as restless sleep, snoring and enuresis following T&A . It has also been demonstrated that children who no longer have OSA following T&A have an improved quality of life .

The clinical practice guideline for polysomnography (PSG) in children prior to T&A identifies those children in whom PSG is recommended . In some children, it is necessary to use a PSG to differentiate OSA from primary snoring. A postoperative PSG has also been recommended in children with severe OSA and others who are at increased risk for persistent obstruction . Furthermore, a PSG helps to distinguish mild from moderate to severe OSA. However studies show that less than 10% of children undergo preoperative PSG, and even smaller percentage undergo postoperative studies . This may be because PSG is expensive, time consuming, labor intensive, and dedicated pediatric sleep labs are not widely available. Moreover, PSG after T&A may be difficult to obtain because of limited availability and restrictions in coverage by insurers or third party payers.

A simple screening tool to better identify those children who are at the risk of having OSA even after T&A that may require PSG is highly desirable. Moreover, clinical variables that can predict resolution and/or improvement of OSA after T&A will reduce the need for a second PSG. Unfortunately, history and physical examination have been shown to be poorly suited to this task. There is controversy about their role in determining which children need treatment . Several approaches have been described that utilize a combination of physical exam findings and parental descriptions of clinical symptoms to diagnose OSA before T&A. However, one universally accepted method has yet to be adopted and scant data is available on clinical predictors after T&A.

We hypothesize that a specific complex of symptoms may help clinicians identify children who are at increased risk of OSA and that the resolution of such symptoms after T&A will indicate the improvement and/or resolution of OSA. To test this hypothesis we asked the parents of children (< 18 yrs.) with suspected OSA to complete a 55-item questionnaire based on their child’s symptoms before and three to six months after T&A. The purpose of this study is to determine whether a simple questionnaire that can be completed by parent(s) can be used as a screening tool to identify children with OSA after T&A and reduce the need for second PSG.