Investigations in paediatric obstructive sleep apnoea: do we need them?

Ninety percent of normal children with obstructive sleep apnoea. (OSA) improve, or are cured, with adenotonsillectomy. However, 10% of apparently normal children show no improvement following this operation and it has a very poor outcome in Down's syndrome, where only about one in six children improve. Adenotonsillectomy is also rarely curative in children with cerebral palsy or craniofacial. syndromes. In these children investigations of the site and severity of their obstruction is necessary. Taking a detailed history and asking the parents to fill in a questionnaire for data collection will identify most children with OSA. Pulse oxymetry has some limitations but is a good screening tool. It does not provide enough information for the management of children with complex upper airway obstruction who are likely to have on going problems with OSA throughout their childhood despite intervention. For these children format steep studies are needed. Full polysomnography is the gold standard investigation to ascertain the severity of OSA. To ascertain the site of upper airway obstruction during steep, steep nasendoscopy has been found to be an excellent tool. This is performed under a tight general anaesthetic in main theatres and is demonstrated using video footage in the presentation. This is a new classification to document the site of airway obstruction in paediatric OSA. A micro-layryngobronchoscopy is also required in any child who has daytime noisy breathing, a previous history of cardiac malformation or Down's syndrome, in whom a more distal site of airway obstruction may be present. (C) 2003 British Association for Paediatric Otorhinolaryngology. Published by Elsevier Ireland Ltd. All rights reserved.