title: Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery.
abstract: OBJECTIVE
  The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting.
  
  
  METHODS
  Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery.
  
  
  RESULTS
  One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p < 0.001), known OSA (p = 0.006), and a scheduled adenotonsillectomy (p = 0.02).
  
  
  CONCLUSIONS
  OSA was not routinely screened for by anesthesia providers prior to ambulatory pediatric surgery. When screening did occur, "snoring" was the most commonly recorded symptom. Paradoxically, patients with undiagnosed OSA who would benefit the most from screening were the least likely to be screened.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 697.
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.|Division of Pediatric Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.|Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Kareem O
authors.initials: KO
authors.lastname: Tawfik
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: David F
authors.initials: DF
authors.lastname: Smith
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Kristin
authors.initials: K
authors.lastname: Cheung
authors.affiliation: Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Pringle
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Stephen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Everett
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Stierer
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D017677:Age Distribution; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D015999:Multivariate Analysis; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017286:Polysomnography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D017751:Safety Management; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome
keywords: OSA; ambulatory; outpatient surgery; pediatric; screening; sleep apnea; surgery