The question a when a child should consider a tonsillectomy /
adenoidectomy for sleep problems is only becoming more complex. Our
increased focus on evidenced-based quality medicine have led us to
critically evaluate the reasons for performing even “simple” surgery
before recommending it.
Children with only moderately enlarged tonsils and vague sleeping complaints (reported by parents), we may consider a sleep study to
definitely quantify the sleep problem before committing to surgery.
The sleep study is an overnight test, done in a comfortable sleep lab,
where the patient is “wired up” with many electrodes to monitor
breathing, blood oxygen, and brainwaves. A technician records the
exam and later the data is put all together and scored to quantify
just what type and degree of sleep problem your child has. The exam
is completely painless and the sleep center is usually made as
comfortable and home-like as possible to encourage good sleep.
The sleep study data can tell us how severe the sleeping problem is, and whether the problem is due to obstruction of breathing or other problems. From this piece of information a scientific decision can be made about surgery.
The big caveat however is that for children no one really knows what a
normal sleep study should be, so we usually err on the side of being
more conservative than in adults. For this reason, pediatric sleep
studies are usually only done when the doctor’s examination and the
symptoms do not paint a clear picture and there is some uncertainty
about the cause of the disturbance.