ADVERTISEMENT
CURRENT ISSUE
APRIL 2014
KINDLE EDITION


SLEEP Seeking New Editor

The APSS is seeking qualified candidates for editor-in-chief of SLEEP



SEARCH JOURNAL ARCHIVES


SEARCH PUBMED


MANUSCRIPT SUBMISSIONS


SUBSCRIBE TO SLEEP

CONTINUING MEDICAL EDUCATION


ADVERTISE WITH US


ABOUT SLEEP

ABSTRACT SUPPLEMENTS


ACCEPTED PAPERS
Bookmark and Share         RSS Feed

VOLUME 34, ISSUE 03

RESPIRATORY INDICATIONS FOR POLYSOMNOGRAPHY IN CHILDREN
Practice Parameters for the Respiratory Indications for Polysomnography in Children

R. Nisha Aurora, MD1; Rochelle S. Zak, MD2; Anoop Karippot, MD3; Carin I. Lamm, MD4; Timothy I. Morgenthaler, MD5; Sanford H. Auerbach, MD6; Sabin R. Bista, MD7; Kenneth R. Casey, MD8; Susmita Chowdhuri, MD9; David A. Kristo, MD10; Kannan Ramar, MD5

1Mount Sinai School of Medicine, New York, NY ; 2Sleep Disorders Center, University of California, San Francisco, San Francisco CA ; 3Penn State University Hershey Medical Center, Hershey, PA and University of Louisville School of Medicine, Louisville, KY ; 4Children's Hospital of NY – Presbyterian, Columbia University Medical Center, New York, NY ; 5Mayo Clinic, Rochester, MN ; 6Boston University School of Medicine, Boston, MA ; 7University of Nebraska Medical Center, Omaha, NE ; 8Cincinnati Veterans Affairs Medical Center, Cincinnati, OH ; 9Sleep Medicine Section, John D. Dingell VA Medical Center, and Wayne State University, Detroit, MI ; 10University of Pittsburgh, Pittsburgh, PA



  Expand  Table of Contents    
Text size:  

Background:

There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine.

Methods:

A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence.

Recommendations for PSG Use:

  • Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard)

  • Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard)

  • Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard)

  • Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard)

  • Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard)

  • Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline)

  • Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline)

  • Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome. (Guideline)

  • Follow-up PSG in children on chronic PAP support is indicated to determine whether pressure requirements have changed as a result of the child's growth and development, if symptoms recur while on PAP, or if additional or alternate treatment is instituted. (Guideline)

  • Polysomnography is indicated after treatment of children for OSAS with rapid maxillary expansion to assess for the level of residual disease and to determine whether additional treatment is necessary. (Option)

  • Children with OSAS treated with an oral appliance should have clinical follow-up and polysomnography to assess response to treatment. (Option)

  • Polysomnography is indicated for noninvasive positive pressure ventilation (NIPPV) titration in children with other sleep related breathing disorders. (Option)

  • Children treated with mechanical ventilation may benefit from periodic evaluation with polysomnography to adjust ventilator settings. (Option)

  • Children treated with tracheostomy for sleep related breathing disorders benefit from polysomnography as part of the evaluation prior to decannulation. These children should be followed clinically after decannulation to assess for recurrence of symptoms of sleep related breathing disorders. (Option)

  • Polysomnography is indicated in the following respiratory disorders only if there is a clinical suspicion for an accompanying sleep related breathing disorder: chronic asthma, cystic fibrosis, pulmonary hypertension, bronchopulmonary dysplasia, or chest wall abnormality such as kyphoscoliosis. (Option)

Recommendations against PSG Use:

  • Nap (abbreviated) polysomnography is not recommended for the evaluation of obstructive sleep apnea syndrome in children. (Option)

  • Children considered for treatment with supplemental oxygen do not routinely require polysomnography for management of oxygen therapy. (Option)

Conclusions:

Current evidence in the field of pediatric sleep medicine indicates that PSG has clinical utility in the diagnosis and management of sleep related breathing disorders. The accurate diagnosis of SRBD in the pediatric population is best accomplished by integration of polysomnographic findings with clinical evaluation.

Citation:

Aurora RN; Zak RS; Karippot A; Lamm CI; Morgenthaler TI; Auerbach SH; Bista SR; Casey KR; Chowdhuri S; Kristo DA; Ramar K. Practice parameters for the respiratory indications for polysomnography in children. SLEEP 2011;34(3):379-388.

Expand  Table of Contents
ADVERTISEMENT
Classifieds View SLEEP 2011 Poster Presentations Online