The Clinical Usefulness of Sleep Studies in Children

doi:10.1016/j.prrv.2015.08.003

Paediatric Respiratory Reviews

Volume 17, January 2016, Pages 53-56

https://doi.org/10.1016/j.prrv.2015.08.003 Get rights and content

Summary

Sleep disordered breathing is common in children and has the potential to have a significant impact on cognition, activity and social interaction. The overnight in-laboratory polysomnography (PSG) continues to be the gold standard instrument for the investigation of sleep-disordered breathing in children. It has the ability to rule in or rule out the need for intervention for common conditions such as obstructive sleep apnoea, assess the role of sleep quality in children and adolescents with hypersomnolence, provide physiologic data in children with hypoventilation as may be seen in neuromuscular disease and assist in the assessment of children with structural airway and lung abnormalities.

Polysomnography is valuable and the only reliable method to differentiate habitual snoring from many levels of sleep apnoea syndrome [1]. The American Academy of Paediatrics recommends that, in order to diagnose and manage OSA syndrome, all children should be screened for snoring and complex cases should be referred to a specialist. PSG is the diagnostic gold standard and adenotonsillectomy is the first line of treatment [2]. There is no evidence to support nap studies or ambulatory sleep studies in children [3]. With adequate staffing, expertise, and a child and family-friendly environment, children of any age can undergo a sleep study.

Section snippets

Variables measured by polysomnography

Sleep architecture, gas exchange, respiratory events, snoring, arousals, limb movements, heart rate and body position are the variables measured in the PSG (Figure 1 – sleep study epoch). The sleep study set up consists of nasal and oral flow measurements, continuous electroencephalogram (EEG) and electrocardiogram (ECG), as well as bilateral electro-oculography (EOG); oxyhaemoglobin saturation and transcutaneous or end-tidal carbon dioxide; continuous electromyography of the genioglossus,

Sleep-related Breathing Disorders

Sleep studies are frequently requested for children suspected of having obstructive sleep apnoea (OSA). OSA is defined as a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnoea) that disrupts normal ventilation during sleep and normal sleep patterns [4].

Adenotonsillectomy (AT) is the first line of treatment for most children [1]. Polysomnography is indicated in children being considered for

Narcolepsy and other causes of excessive daytime sleepiness (EDS)

Overnight polysomnography followed by a multiple sleep latency test (MLST or “nap test”) are the most important diagnostic tools for objectively measuring the degree of EDS in conjunction with sleepiness scales and sleep diaries. The overnight polysomnography, in the context of hyper- somnolence, is important in order to exclude sleep disordered breathing as a cause of excessive sleepiness and to also document abnormal sleep structure observed in children with narcolepsy. The MSLT employs an

Conclusion

The overnight polysomnography (PSG) continues to be the gold standard instrument for the investigation of sleep-disordered breathing in children. It measures sleep and respiratory physiology, as well as its pathophysiology. There is no evidence to support nap studies or ambulatory sleep studies in children. Sleep architecture, gas exchange, respiratory events, snoring, arousals, limb movements, heart rate and body position are the variables measured in polysomnography. It is valuable and the

Educational Aims

The reader will come to appreciate that:

•
Polysomnography is the gold standard for diagnosis and management of sleep disordered breathing in infants and children.
•
There are respiratory and non-respiratory indications for performing polysomnography.
•
Polysomnography is an important tool in the diagnostic work-up of children with excessive daytime sleepiness.

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Using prospectively collected data, children aged 4–17yr were grouped into two categories based on whether or not they had symptoms of SDB. Perioperative variables were compared between the exposed and control groups using Chi-squared test for categorical or t-test for continuous variables. Logistic regression analysis was used to assess the association between SDB and the odds of requiring PACU IV opioids.
Children with preoperative SDB symptoms (N = 325) compared with the reference group of children who did not have these symptoms had higher rates of PACU analgesic intervention (47.1% vs. 37.4%; p = 0.004) and higher mean arousal pain scores (3.7 ± 3.5 vs.1.9 ± 2.9; p < 0.001). In our primary multivariable logistic regression model adjusted for a number of variables, preoperative SDB symptoms was associated with a two-fold increased odds of receiving PACU intravenous opioid (OR = 2.01, 95%CI, 1.29–3.12; p = 0.002).
These results suggest that preoperative SDB symptoms in children undergoing ambulatory surgery, exerts a significant influence on PACU pain behavior and analgesic requirement. Mechanisms underlying this enhanced pain experience deserve further elucidation.
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Clinical usefulnessThe Clinical Usefulness of Sleep Studies in Children

Summary

Section snippets

Variables measured by polysomnography

Sleep-related Breathing Disorders

Narcolepsy and other causes of excessive daytime sleepiness (EDS)

Conclusion

Educational Aims

Chest

Seminars in Pediatric Neurology

Electroencephal Clinical Neurophysiol

J Pediatrics

Diagnosis and management of childhood obstructive sleep apnoea syndrome

Pediatrics

Clinical Practice Guideline: diagnosis and management of childhood obstructive sleep apnoea syndrome

Pediatrics

American Academy of Sleep Medicine. Practice Parameters for the respiratory indications for polysomnography in children

Sleep

Clinical usefulness
The Clinical Usefulness of Sleep Studies in Children