Practice Patterns for the Management of Pediatric oSDB: What Is the Current National Landscape?

Abstract

As understanding of pediatric obstructive sleep-disordered breathing (oSDB) evolves, a need remains for clinical consensus within pediatric otolaryngology. We aimed to characterize current national practice patterns in the evaluation and management of pediatric oSDB, including obstructive sleep apnea (OSA), among pediatric otolaryngologists. We performed a cross-sectional study of the current 450 ASPO members via an anonymous, confidential, secure, and voluntary online survey. The survey queried practicing pediatric otolaryngologists regarding tonsillectomy techniques, drug-induced sleep endoscopy (DISE), and multidisciplinary care in the management of pediatric oSDB. Of the 450 current ASPO members invited to participate, 212 (47%) completed the survey. There was wide variability with respect to extracapsular versus intracapsular tonsillectomy techniques for oSDB and OSA indications, with 70% performing intracapsular dissection as part of their practice. A total of 169 respondents (81%) performed DISE, with almost all respondents (99.1%) using a standardized grading scale. Practice patterns did emerge, with more junior surgeons (in practice < 10 years) and those in academic practice being more likely to perform intracapsular tonsillectomy and DISE in clinical practice compared to more senior counterparts and those working in a nonacademic setting (p < 0.05 for each metric). Multi-disciplinary care of complex or persistent OSA was more common in academic versus nonacademic settings (64% vs. 26%) (p < 0.001). Notable variability in pediatric oSDB management across the current national landscape highlights the need to standardize aspects of care, including the role of intracapsular tonsillectomy, pediatric DISE protocols, and multidisciplinary care.