American Academy of Pediatrics – Section on Pediatric Pulmonology and Sleep Medicine

Do not interpret pediatric sleep studies using adult standards. Pediatric sleep studies should be performed and interpreted according to pediatric standards, even if performed in a laboratory that predominantly studies adults.

Clinicians should use the AAP “Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome” to determine who might benefit from ordering a sleep study or polysomnogram. In addition, the practitioner should determine in which laboratory the polysomnogram may be most appropriately conducted. Testing should evaluate physiological parameters that include cardiac, respiratory, and central nervous system functions. Because of the complex nature of the testing, sleep laboratories must have experience with children to perform an adequate test. Inclusion of caregivers is vital in providing a child-friendly environment. It is suggested that the referring physician inquire about the experience that the sleep laboratory personnel have with children prior to making a referral. If the study is not performed by personnel who can properly interpret pediatric studies, then the study would need to be repeated in a pediatric sleep center, thereby adding to the cost of the evaluation. Differences exist between normal values for adults and children with regard to sleep-disordered breathing. Obstructive events while asleep are uncommon in children, so their presence needs to be thoroughly assessed. In adults, the frequency of obstructive apneas increases with age, and the oxygen saturation while asleep may dip lower than in children. Therefore, it is vital that the diagnosis of obstructive sleep apnea (OSA) be made on the basis of pediatric criteria. Further, the severity determination of OSA must take into account the patient’s age, because these values are different in children than adults.

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