Polysomnography for the diagnosis of sleep disordered breathing in children under 2 years of age

Abstract

Summary. Objectives: To describe clinical polysomnography (PSG) results, sleep physicians' diagnosis, and treatment of sleep disorder breathing in children less than 2 years of age. Study Design: Retrospective clinical chart review at a pediatric tertiary care center, pediatric sleep laboratory. Subject Selection: Children less than 2 years of age who underwent clinical PSG over a 3-year period. Methodology: PSG results and physician interpretations were identified for inclusions. Children were excluded if either PSG results or physician interpretations were unavailable for review. Infants were classified in three age groups for comparison: <6 months, 6-12 months, and >12 months. Results: Matched records were available for 233 PSGs undertaken at a mean age 11.1 AE 7.0 months; 31% were <6 months, 23% were 6-12 months, and 46% were 12-24 months of age. Infants <6 months showed significant differences on sleep parameters and respiratory indicators compared to other groups. Compared to physician sleep disordered breathing (SDB) classification, current pediatric apnea-hypopnea index (AHI)-based SDB severity classification overestimated SDB severity. Age and obstructive-mixed AHI (OMAHI) were most closely associated with physician identification of SDB. Conclusion: Children <6 months of age appear to represent a distinct group with respect to PSG. Experienced sleep physicians appear to incorporate age and respiratory event frequently when determining the presence of SDB. Further information about clinical significance of apnea in infancy is required, assisted by identification of factors that sleep physicians use to identify SDB in children <6 months of age.

Associations between age and sleep apnea risk among newborn infants

“…Healthy full‐term neonates have higher frequency of apneas and hypopneas than older children (mean neonatal apnea‐hypopnea index, AHI, was reported to be 14.9 ± 9.1 among 30 healthy infants, with neonatal obstructive AHI 2.3 ± 2.5, while obstructive AHI > 1 is considered abnormal for children > 12 months of age) . Despite clinical observations of sleep‐disordered breathing (SDB) patterns on polysomnography, parameters to guide clinically appropriate diagnostic limits for SDB are not currently well‐defined for neonates or infants < 1 year …”

“…3,4 Despite clinical observations of sleep-disordered breathing (SDB) patterns on polysomnography, parameters to guide clinically appropriate diagnostic limits for SDB are not currently welldefined for neonates or infants < 1 year. 5 Infants who are born prematurely are predisposed to adverse cognitive outcomes 6 and appear to be at risk for later SDB. 7 Habitual snoring with associated arousals, even in the absence of measurable sleep apnea, among infants is associated with suboptimal motor developmental scores.…”

Pediatric Pulmonologyyear in review 2015: Part 2

“…Information on the criteria to be used to determine SDB in infants remains largely nonexistent. In a retrospective study on 233 infants <2 years, De Haan et al identified infants <6 months as a distinct group with significant differences in PSG sleep and respiratory indices compared to older groups. Compared to SDB classification by experienced sleep physicians, the pediatric apnea‐hypopnea index (AHI) overestimated SDB severity in infants <6 months.…”

Diagnostic utility of polysomnography in children less than 2 years of age?

“…Without this information, however, Experienced clinicians will use alternative clinical criteria to define severity . This is based on clinical experience, which makes it imprecise—different clinicians will weight various clinical parameters differently.…”

“…Children under 2 years of age have specific anatomical and physiologic factors that make them uniquely at risk for SDB. 3 In the article, in this issue, by Dr. DeHaan et al, 4 three experienced sleep physicians evaluated a group of children in this age group, referred for evaluation of suspected SDB. These children also underwent standard polysomnography (PSG).…”