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

View all recommendations from this society

Released August 17, 2020

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.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The AAP Section on Pediatric Pulmonology and Sleep Medicine (SOPPSM) expressed interest in Choosing Wisely at Celebration of Pediatric Pulmonology in 2015. Over the course of the 2-day meeting, group breakouts occurred during which the attendees identified the top 21 potential Choosing Wisely recommendations. These were voted on and ranked by the attendees. The AAP Section on Pediatric Pulmonology and Sleep Medicine (SOPPSM) membership was then surveyed to select the top 5 items on the basis of the scientific evidence provided. The list was extensively peer reviewed, refined, and approved by all relevant AAP Committees, Councils, and Sections. The AAP Board of Directors and Executive Committee awarded the final approval.

AAP’s disclosure and conflict of interest policy can be found at


Marcus CL, Omlin KJ, Basinki DJ, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992;146(5 Pt 1):1235-1239.

Alsubie HS, BaHammam AS. Obstructive sleep apnea: children are not little adults. Paediatr Respir Rev. 2017;21:72-79.

Katz ES, Marcus CL. Diagnosis of obstructive sleep apnea. In: Sheldon SH, Ferber R, Kryger MH, Gozal D, eds. Principles and Practice of Pediatric Sleep Medicine. Philadelphia, PA: Elsevier Saunders; 2014:221-230.

Wagner MH, Torrez DM. Interpretation of the polysomnogram in children. Otolaryngol Clin North Am. 2007;40:745-759.

Marcus CL, Brooks LJ, Draper KA, et al; American Academy of Pediatrics. Clinical practice guideline. Diagnosis and management of childhood obstrucive sleep apnea syndrome. Pediatrics. 2012;130(3):576-584.