Unsupervised polysomnography in children: a technical and economic study

Introduction: Obstructive sleep apnea syndrome (OSA) in children is related to hypertrophy of the tonsils, adenotonsillectomy being the treatment of choice. However, perioperative risks are not well established, assessment of routine preoperative polysomnography not feasible. The objective of the study was to evaluate the economic and technical viability (frequency of failure) of unsupervised polysomnography in children before adenotonsillectomy. Methods: The prospective study was approved by the local research ethics committee. 146 children, 57 male, aged 3 to 11 years, with indication of adenotonsillectomy, were invited to preoperative polygraphic monitoring. We analyzed the frequency of failed exams, failures per sensor, its correlation to age of the children and compared costs to standard full-night polysomnography. Results: General failure rate was 28.08% (n = 41), with no difference between genders (χ2=0.0644 p=0.7997), but a greater risk for preschool children (RR =1.2386 (CI 95%: = 0.724 to 2.118). Failure of oximetry was observed in 14.3%, nasal cannula in 10.2%, combination of both in 4.1%., thoracoabdominal belt in none. Costs of the unsupervised PSG was estimated to be 63% of the standard PSG, even if including the high failure rate being more cost saving. Conclusion: Unsupervised polysomnography was technically and economically feasible, its installation to be performed by trained professionals to avoid failure of sensors, mostly oximetry.