Abstract
Sleep affects control of breathing and ventilation both in children and adolescents who are healthy as well as those who have underlying respiratory, cardiovascular, or neurologic disorders. This chapter discusses the utility of nocturnal in-lab polysomnography in assessing children for sleep-related breathing disorders. The diagnostic and treatment indications for pediatric polysomnography are reviewed based on recently published guidelines. The respiratory and nonrespiratory components of a polysomnogram are reviewed, so are the reported parameters from such a study. Challenges involved in conducting and interpreting pediatric polysomnograms are discussed, including diagnostic and treatment (positive airway pressure titration) studies.
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Obstructive apnea: Cessation of airflow (≤90 % of baseline) >10-s duration or two baseline breaths (in children) with continued or increased respiratory effort. This is scored on the nasal thermistor channel. An oxygen desaturation is not required to score the event.
Central apnea: Cessation of airflow without respiratory effort ≥20 s or if less than 20 s must be associated with arousal/awakening or ≥3 % O2 desaturation.
Mixed apnea: Initial central apnea followed by chest and abdominal movements with a lack of airflow >10 s in duration (or at least two breaths in children).
Hypopnea: ≥30 % reduction airflow associated with arousal/awakening or ≥3 % O2 desaturation. When scoring obstructive hypopneas the nasal pressure transducer channel is used.
Periodic breathing: At least three central apneas in succession which are a minimum duration of 3 s, and are separated by no more than 20 s of regular respiration: This is a pattern of breathing seen more commonly in infants, especially premature babies. Normal values for premature infants are <5 % of sleep time, and for term infants <3 % of sleep time. This pattern disappears as the infant matures and its continued presence may reflect underlying central nervous system immaturity or anemia.
Hypoventilation: End-tidal carbon dioxide greater than 50 mmHg for more than 25 % of the total sleep time. Hypoventilation is assessed by measuring end-tidal CO2.
Cheyne-Stokes respiration: Central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume.
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Sami, I.R., Owens, J.A. (2015). Polysomnography for the Pediatric Pulmonologist. In: Davis, S., Eber, E., Koumbourlis, A. (eds) Diagnostic Tests in Pediatric Pulmonology. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1801-0_11
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DOI: https://doi.org/10.1007/978-1-4939-1801-0_11
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