The purpose of this study was to pick up variation of practice across the UK in the assessment and management of children with suspected OSA, particularly with reference to pulse oximetry and polysomnography. A questionnaire-based survey revealed that preoperative pulse oximetry was used by 71% of the respondents in children with suspected OSA. In some places, funding issues governed the use of this investigation. Only 31% used this postoperatively, guided by clinical factors and anaesthetists’ requirements. Fewer performed polysomnography which, according to The American Academy of Paediatrics, is the gold standard. Restrictions in performing polysomnography are mentioned. Referral to a tertiary centre was based on age less than two years and co-existing morbidities. Only 8% reassured patients on the basis of negative pulse oximetry, which shows it is not reliable to exclude OSA. The study reveals a wide variation in practice within the UK where only 25% had a dedicated protocol. The author’s clinical protocol is outlined, which provides useful guidance because careful history and clinical examination have a very significant role in managing this complex problem.
Investigations in the management of OSA in children
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