title: Nocturnal polysomnographic characteristics of habitually snoring children initially referred to pediatric ENT or sleep clinics.
abstract: OBJECTIVE
  To determine clinical and polysomnographic characteristics of children initially referred by primary care physicians (PCP) to either otolaryngology or sleep clinics for a history of habitual snoring.
  
  
  METHODS
  Retrospective review of clinical characteristics and nocturnal polysomnograms (PSG) of snoring children referred initially to otolaryngologists by PCP (i.e., ENT) compared to a cross matched population of snoring children initially referred to a pediatric sleep center (i.e., SLEEP).
  
  
  RESULTS
  Sixty-eight ENT referred children were cross-matched to 68 SLEEP children. ENT referred children were found to have significantly larger tonsillar size compared to SLEEP children (tonsil size score 3.1 vs. 2.5, p value <0.01). Despite larger tonsillar size, there were no differences observed in the number of children with clinically significant obstructive sleep apnea syndrome (OSAS) with an obstructive apnea hypopnea index (OAHI)5/h TST (40 ENT vs. 38 SLEEP children). Furthermore, SLEEP children with OSAS exhibited more severe sleep related breathing disturbances compared to ENT children (obstructive apnea index: 5.0 vs. 1.5 /h TST, p value <0.01; mean oxygen saturation nadir [76.3% vs. 87.0%, p<0.01]). Finally, in 28 ENT referred children vs. 30 SLEEP the OAHI was <5/h TST.
  
  
  CONCLUSIONS
  Children referred by ENT are not more likely to be diagnosed with OSAS than snoring children directly referred to a pediatric sleep clinic by their pediatricians. The only difference in the referral decision between ENT and SLEEP seems to be tonsil size. Furthermore, PSG revealed a large percentage of children in whom surgical indication for AT is not obvious, thus suggesting that PSG is useful in determining the management of snoring children initially referred to ENT. Finally, SLEEP referred children diagnosed with OSAS exhibited increased indices among selected parameters indicative of sleep-disordered breathing.
authors.affiliation: Department of Pediatrics, University of Louisville, KY 40202, USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Bhattacharjee
authors.forename: Ehab
authors.initials: E
authors.lastname: Dayyat
authors.forename: Leila
authors.initials: L
authors.lastname: Kheirandish-Gozal
authors.forename: Oscar
authors.initials: O
authors.lastname: Sans Capdevila
authors.forename: David
authors.initials: D
authors.lastname: Gozal
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010036:Otolaryngology; D017286:Polysomnography; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012913:Snoring / Q000209:etiology / Q000503:physiopathology*