Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center

Abstract

BackgroundPolysomnography (PSG) is the gold standard for the diagnosis of pediatric sleep‐disordered breathing (SDB). However, the literature characterizing the indications for inpatient PSGs and the impact on clinical decision‐making is limited.ObjectiveTo determine the indications, results, and outcomes for children undergoing inpatient PSGs at our institution.MethodsWe performed a retrospective review of children aged 0–18 years who underwent inpatient diagnostic PSGs between July 2018 and July 2021 at SickKids, Toronto, Canada. Baseline characteristics, indications, and management were reviewed and characterized by descriptive statistics.ResultsEighty‐eight inpatient PSGs were performed in 75 children (male 62.7%). Median (interquartile range) age and body mass index z‐score were 1.5 (0.2, 10.8) years and 0.27 (−1.58, 2.66), respectively. The most common indication for inpatient PSG was initiation and titration of ventilation (n = 34/75, 45.3%). Of the 75 children, 48 (64%) had multiple complex chronic conditions (CCCs). Sixty children (80%) underwent a baseline PSG for either the entire night or a portion of the night. Of these studies, 54 (90%) had clinically significant SDB of which isolated obstructive sleep apnea (OSA; 17/60, 28.3%) was the most common. The following management was undertaken for the 54 patients with SDB; respiratory technology (88.9%), surgical intervention (31.5%), positional therapy (1.9%), intranasal steroids (3.7%), and no further intervention (5.6%), respectively.ConclusionsOur study highlights that inpatient PSG was an important diagnostic tool resulting in directed medical and surgical management. Future multicenter studies are needed to compare indications for inpatient PSGs across institutions to develop evidence‐based clinical practice guidelines.

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

“…INS have an anti-inflammatory effect that reduces the release of inflammatory mediators and inhibits inflammatory cell recruitment to the nasal mucosa [43]. It was demonstrated that inflammatory mediators and their expression is increased in the nose and pharynx of patients with OSA [44]. In support of this, neutrophilic cells in sputum and elevated inflammatory markers (leukotrienes, prostaglandins) in exhaled breath condensate were found.…”

“…Furthermore, the presence of two isoforms of glucocorticoid receptors (GRC-alpha and GCR-beta) were demonstrated in adenoid and tonsil tissues [45]. It is not known whether this receptor expression is a cause or a consequence of the disease, but it is associated with a greater response to INS therapy in children with OSA [44]. Lastly, lowgrade chronic systemic inflammation was also described, as demonstrated by the increase in the serum C-reactive protein and proinflammatory cytokines [10,46].…”

“…INS have a higher benefit-to-risk ratio than systemic corticosteroids and may be used for longer periods since they mainly act on nasal mucosa [43,44]. Local adverse effects of INS include epistaxis, nasal irritation, dry nose, candidiasis, and pharyngitis, but these are reported to be no more frequent than with a placebo [47].…”

The Role of Telemedicine in Children with Obstructive Sleep Apnea Syndrome (OSAS): A Review of the Literature

“…Anti-inflammatory therapies, such as topical steroids, can be useful [66] by reducing the release of inflammatory mediators that may cause nasal obstruction in individuals with allergic rhinitis and adenoid hypertrophy [67,68]. The use of inhaled steroids, compared to systemic steroids, results in lower systemic absorption by acting locally on the nasal mucosa [69]. The most commonly used corticosteroids are budesonide, fluticasone, and mometasone [67].…”