Polysomnography provides valuable information for diagnosing or ruling out a wide range of sleep disorders and sleep-related breathing disorders in children of all ages. Umakanth Khatwa, MD, director of Boston Children's Hospital's Sleep Laboratories, explains what polysomnography entails and highlights its important clinical applications.
What is a polysomnogram and what does it involve?
A polysomnogram is a continuous recording of multiple physiological parameters during sleep.
Polysomnography requires a child to sleep throughout the night in the sleep laboratory. Before the sleep study begins, a sleep technologist applies various sensors to the child's head, eyes, nose, chin, legs, chest and abdomen. These include:
The child will also be video- and audio-recorded in order to evaluate his body position during sleep and to detect any snoring.
When is a polysomnogram advisable for a pediatric patient?
Polysomnography is indicated for the diagnosis or ruling out of:
- obstructive sleep apnea
- central sleep apnea
- sleep-associated hypoventilation
- periodic breathing
- periodic limb movements of sleep
- sleep state misperception (meaning the child perceives that he is not asleep, although he actually is)
- atypical parasomnias (physically acting out while dreaming)
- nocturnal events (like confusional arousals and nocturnal panic attacks) vs. nocturnal seizures (such as those caused by frontal lobe epilepsy)
- titrate positive airway pressure therapy (continuous positive airway pressure and bi-level positive airway pressure)
Polysomnography is not indicated for the diagnosis or ruling out of:
- behavioral insomnias of childhood (bedtime resistance or problems staying asleep that are caused by an inappropriate sleep environment and/or poor sleep routines and habits)
- restless leg syndrome
- typical childhood parasomnias (such as nightmares, night terrors or sleepwalking)
- Circadian sleep disorders (difficulty sleeping or waking at desired times because of dyssynchrony between the body's "internal clock" and the actual time of day)
Can a polysomnogram be ordered for any child?
Yes, a polysomnogram can be ordered for a child of any age, including children with special needs.
What happens after a polysomnogram?
Once the polysomnogram is complete, the recorded data is downloaded, reviewed, scored and read by a board-certified pediatric sleep physician. This process normally takes between one and two weeks.
The results are then uploaded to the child's electronic medical record, an email notification is sent to the referring physician and a copy of the report is faxed to the physician's office.
Here at Boston Children's, our sleep physicians are always available to discuss sleep study reports with referring physicians.
What are the potential challenges associated with polysomnography for children?
If a child has a second sleep disorder—such as insomnia—that is not identified and/or treated before the polysomnogram, he may have trouble sleeping in the laboratory setting. This, in turn, will limit the amount of useful data collected during his sleep study—making it difficult to comment categorically on the presence or absence of the primary disorder in question, such as sleep apnea.
Some children may require a pre-polysomnogram visit to the sleep laboratory to acclimatize to and become familiar with the lab environment. This can substantially reduce their apprehension and anxiety, as well as their parents'—leading to a better quality study and a much more positive experience for everyone.
If a child needs some degree of acclimatization before his polysomnogram, Boston Children's Center for Pediatric Sleep Disorders can arrange a referral to our multidisciplinary sleep clinic for a comprehensive sleep evaluation and a tour of our sleep laboratory.
What are the benefits of conducting a polysomnogram in a pediatric-specific sleep laboratory?
Pediatric-specific sleep laboratories, like those at Boston Children's Boston and Waltham locations, create a soothing and welcoming atmosphere for children and their families. From child-friendly décor and amenities—including videos and games that encourage relaxation before sleep—to providing a bed for parents to spend the night alongside their children, every aspect of our labs is designed with the needs of children and families in mind.
Most importantly, our sleep laboratories are staffed by pediatric sleep physicians, sleep technologists and sleep nurses who work with children every day. Our staff members understand and can anticipate the concerns and questions young patients and their parents are likely to have—meaning we are able to address those issues in a compassionate, reassuring and informative way.
More information: childrenshospital.org/sleep
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