A 5-year-old with enlarged tonsils, recurrent throat infections, snoring, and concerns about sleep. What is the next step to evaluate for sleep-disordered breathing?

A 5-year-old with enlarged tonsils, recurrent throat infections, snoring, and concerns about sleep. What is the next step to evaluate for sleep-disordered breathing?

• A. Continue to observe for two or more GABHS infections.
• B. Prescribe prophylactic antibiotics to prevent recurrence.
• C. Refer to a pulmonologist for polysomnography evaluation.
• D. Refer to an otolaryngologist for possible tonsillectomy.

Answer: (C)

When a child has snoring and concerns about sleep along with enlarged tonsils, the concern is obstructive sleep-disordered breathing. The next step is to obtain a pediatric sleep study (polysomnography) to confirm whether obstructive sleep apnea is present and to gauge its severity. Polysomnography records brain activity, eye movements, muscle tone, heart rate, breathing effort, airflow, and oxygen levels during sleep, providing an objective diagnosis that guides treatment. If the study shows OSA, especially related to tonsillar hypertrophy, management can then consider tonsillectomy as appropriate. Observing the child or giving antibiotics for recurrent throat infections does not evaluate sleep-disordered breathing and won’t determine if sleep apnea is present. An ENT referral for possible tonsillectomy may come after PSG confirms OSA and helps inform the decision, rather than serving as the immediate evaluation step.

When a child has snoring and concerns about sleep along with enlarged tonsils, the concern is obstructive sleep-disordered breathing. The next step is to obtain a pediatric sleep study (polysomnography) to confirm whether obstructive sleep apnea is present and to gauge its severity. Polysomnography records brain activity, eye movements, muscle tone, heart rate, breathing effort, airflow, and oxygen levels during sleep, providing an objective diagnosis that guides treatment. If the study shows OSA, especially related to tonsillar hypertrophy, management can then consider tonsillectomy as appropriate.

Observing the child or giving antibiotics for recurrent throat infections does not evaluate sleep-disordered breathing and won’t determine if sleep apnea is present. An ENT referral for possible tonsillectomy may come after PSG confirms OSA and helps inform the decision, rather than serving as the immediate evaluation step.