Sleep studies are gold standard to diagnose sleep apnea in children. Actually, kids need to have formal sleep study, whereas adults can be diagnosed with sleep apnea on in-home sleep studies as well. So far it is not recommended to do in-home studies for kids. Kids should have formal sleep studies.

Thanks so much Imran & Shaikh, would you provide me with published articles or guideline which support your opinion. Shaikh -I deal frequently with pediatric cases of adenotonsillar hypertrophy associated with apneic spells during sleep & my diagnosis is obstructive upper airway disease (adenotonsillar hypertrophy) with ?? OSA, to which adenotosillectomy is performed & i keep these patient in recovery room on monitor & strict F/U by anasthesia team for at least 2 hours postoperatively to avoid pulmonary oedema, Is it enough? or i have to request preop. blood gases to rule out CO2 retention. If there is CO2 retention, is it enough to keep these patient in recovery room on monitor & strict F/U by anasthesia team for at least 2 hours postoperatively to avoid pulmonary oedema /or PSG should be done before surgery?

Have you considered looking at the occlusion of the child and palatal height at the same time as considering the T&A.  Also, tongue position and verification of nasal vs. mouth breathing should be looked at.  If a posterior cross bite is present then you have a narrow posterior airway space and rapid palatal expansion should be considered along with the T&A.  Also, when T&A is performed, to reduce the convalescence time why not leave the tonsillar sac since  their is only a 3-5% chance of regrowth but it is allot less traumatic to the child and therefore parents.

Most children with OSA have very large tonsils and large adenoids in X ray In these patient I proceed directly to do adeno-tonsillectomy with excellent results, However if there other anatomical abnormality like micrognathia or congental laryngeal stridor I do first radilogicl and endoscopic studies to locate the  anatomical site of obstruction --  Polypsomnography is needed  in cases with nervous abnormality to diagnose central apnea which will not respond to surgery.  Do not miss medical conditions as crtinism (hypothyroidism which respond very good with medical treatment. In short my policy is concerned with anatomical diagnosis more than polypsonsogrphy

I agree with what you are saying, but the studies are showing that tongue level associated with mouth breathing and snoring are also implicated in Sleep Disordered Breathing (SDB).  Also, if the tongue situation is not corrected there is more of a chance post pubertal for  SDB to return.  Of course if the population is more inclined to breast feeding then the natural development of a proper tongue placement, palatal height, occlusion, side plumb line, swallowing pattern and posterior airway space will be developed.  Since many countries are not experiencing normal breast feeding but rather bottle feeding, you will probably have more of an issue in non-breast fed populations.  This is where the field of Myofunctional Therapy enters into the picture.

My policy in children is very simple. If the exploration reveals an enlargement of the tonsils and adenoids, I perform an adenoidectomy with tonsil reduction.                          Polysomnography , in my opinion, only is needed in cases which will not respond to surgery.

In the other cases, we have to think about that is an expensive and uncomfortable test in children.

On the contrary, in adults I recommend Polysomnography in most of the cases

I agree with you, but that is only part of the answer.  One should also look at nasal patency, if the child is a mouth breather, tongue level. whether their is a need for rapid palatal expansion that will inherently provide for a wider posterior airway space as an adult, anterior open bite leading to mouth breathing, tongue tie and side plumb line (mandibular growth follows the tongue creatig long face syndrome.).

I agree. I always look the dental and facial aspects.Most of these patients have a Type II Malocclussion (Angle,s  clasification), and some of them a cross-bite.And the reason is, in most of the cases, the oral breathing. Moss theory: the changes in the function (= in this case breathing) cause a change in growth  of the stomatognatic area.These patients are a good example.When we open the oral cavity, the inferior maxil.la s lowering and going behind(=retrognatia=skeletical type II malocclussion).

The only real way you will correct this is with Myofunctional Therapy MFT) and correcting from a oral to nasal breathing pattern along with proper tongue placement.  I cannot make the statement about occlusion Class for kids, but the most prominent occlusion is  Class I in adults.  Many experienced serial extraction so they were probably Cl. II to begin with.  For the last year we have treated these cases with MFT using telemedicine with my therapists exclusively getting good results.  

In relation to this, we have published a protocol of exploration of the children, with all these factors (14 in total), suchs as Tonsil size, adenoids size, bite occlusion, dental alignement, inferior lingual frenum.........We believe that is very useful and practical.

It has been made by a group of dentists, orthodontic specialists, speech therapysts and me (Ear, Nose and Throat specialist).

If anybody is interested  ,he can send his email direction and I am going to send these protocol in English.

Please forward it to me at,    [email protected]

Please, let me know if you can open de file attach (see below)

It is a pleasure to be communicating with someone that is up on the research and is actually applying it.  You have no idea how hard it is to get the medical practitioner up on what you have already in your treatment protocol.  With your permission I will be forwarding your form to most all the MDs I work with.  Thank you, Merry Christmas and Happy Holidays.  

Thank you very much for our interest.

Of course, you have permission to send the protocol to other colleagues.

merry Christmas and happy New year, Martin.

Thanks so much  Jordi  for your valuable sharing. I hope you send to me also this valuable protocol.

Polysomnography can be used to perform accurate diagnosis regarding the presence and severity of apnea in children. However, the other aids mentioned above such as tonsil size, behaviour issues, noctural enuresis, etc. can help to screen the patients.

Thanks Shivam for your sharing.