Paeds Cases · respiratory-sleep-and-airway
Paediatric sleep investigations: polysomnography, sleep-study interpretation and MSLT — structured case
Structured encounter working through the investigation of a snoring, poorly growing preschooler: choosing attended polysomnography over a limited study, interpreting the resulting report and its apnoea-hypopnoea index against paediatric thresholds, distinguishing obstructive from central events and confirming there is no hypoventilation on carbon dioxide, selecting adenotonsillectomy and follow-up, and finally pivoting to a sleepy adolescent to test the prerequisites and interpretation of the multiple sleep latency test.
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Station 1 — choosing the investigation
Asked how I would investigate this snoring, inattentive, poorly growing preschooler, I explain that her story is a breathing problem, so I want an overnight study rather than a daytime test. I would arrange attended in-laboratory polysomnography as the reference standard because it records brain and breathing together and can classify and grade the events; where laboratory access is limited, oximetry or a limited study can confirm clearly positive disease but a negative result would not exclude apnoea in so symptomatic a child. [1] [3]
References8ShowHide
- [1]Marcus CL; Brooks LJ; Draper KA; et al Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012.PMID 22926173
- [2]Kaditis AG; Alonso Alvarez ML; Boudewyns A; et al Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J, 2016.PMID 26541535
- [3]Aurora RN; Zak RS; Karippot A; et al Practice parameters for the respiratory indications for polysomnography in children. Sleep, 2011.PMID 21359087
- [5]Aurora RN; Lamm CI; Zak RS; et al Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. Sleep, 2012.PMID 23115395
- [6]Accardo JA; Shults J; Leonard MB; et al Differences in overnight polysomnography scores using the adult and pediatric criteria for respiratory events in adolescents. Sleep, 2010.PMID 21061855
- [7]Berry RB; Ryals S; Wagner MH Use of Chest Wall EMG to Classify Hypopneas as Obstructive or Central. J Clin Sleep Med, 2018.PMID 29734977
- [9]Kotagal S; Chopra A Pediatric sleep-wake disorders. Neurol Clin, 2012.PMID 23099134
- [10]Withers A; Pettigrew G; Filmer K; et al Comparing home polysomnography with transcutaneous CO2 monitoring to laboratory polysomnography in children with neuromuscular disorders. J Clin Sleep Med, 2025.PMID 39663926