Development of a pediatric obstructive sleep apnea triage al
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.

Researchers 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 physicians, was used to identify significant predictors of AT. Three triage algorithms were subsequently generated based on the univariate and multivariate results to predict AT.

- From the OSA cohort, there were 469 eligible children, 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.

- Using only tonsil size, the second algorithm had an OR to predict AT of 9.11.

- 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.

Tonsil size was the strongest predictor of AT, while oximetry helped stratify individual risk for AT. Researchers recommend that referral letters for snoring children include graded tonsil size to aid in the triage based on the findings.

Journal of Otolaryngology-Head & Neck Surgery volume