Paediatric sleep investigations: polysomnography, sleep-study interpretation and MSLT — branching viva

Opening — choosing the test

The examiner begins: a four-year-old snores nightly with witnessed pauses and is inattentive by day. What investigation would you choose and why? ^[1]

I would arrange attended in-laboratory polysomnography, the reference standard, because it records brain and breathing together and can classify and grade the events rather than merely detect desaturation. It answers a breathing question, so the overnight study, not a daytime test, is what I need. If laboratory access were limited I would use oximetry or a limited study knowing a negative result would not exclude apnoea in so symptomatic a child. ^{[3] [2]}