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.

structured clinical encounter2 min readVerification in progress

Prompt

A four-year-old girl snores nightly with witnessed pauses and gasping, sleeps restlessly and is inattentive at kindergarten, with large tonsils and weight tracking on the tenth centile. You are the paediatric registrar choosing the investigation, interpreting the polysomnogram, planning treatment, and later evaluating a sleepy adolescent for narcolepsy.

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]

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You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References8Show ledger

[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