INDICATIONS AND RECOMMENDED DIAGNOSTIC STUDIES IN CHILDREN

INDICATIONS FOR POLYSOMNOGRAPHY IN CHILDREN UNDERLYING CHRONIC LUNG DISEASE: BPD, CF, ASTHMA NEUROMUSCULAR DISEASE ALVEOLAR HYPOVENTILATION SYNDROME OBSTRUCTIVE SLEEP APNEA INFANTILE APNEA/ ALTE

ADDITIONAL INDICATIONS FOR PSG IN CHILDREN SUSPECTED NOCTURNAL SEIZURES (VIDEO EEG) SUSPECTED NARCOLEPSY (MSLT NEXT DAY) VENTILATOR FOLLOWUP (YEARLY) CPAP ADJUSTMENT (q 2 YEARS & PRN)

BRONCHOPULMONARY DYSPLASIA (BPD) HIGH RISK GROUP FOR OSA EXTENDED O2 MONITORING IN ALL PATIENTS, AWAKE, ASLEEP & FEEDING NOCTURNAL O2 MONITORING IF O2 <92% WHEN AWAKE NAP OR NOCTURNAL PSG IF APNEA, BRADYCARDIA OR OSA IS SUSPECTED

CYSTIC FIBROSIS NOCTURNAL O2 MONITORING IF AWAKE PaO2 < 72mmHG PSG IF SNORING, DESATURATION ON NIGHTTIME O2 PSG IF PROGRESSION OF COR PULMONALE, POLYCYTHEMIA OR DISTURBED SLEEP ON O2

ASTHMA NOT ROUTINELY RECOMMENDED

NEUROMUSCULAR DISEASE PSG IF DIAPHRAGM IMPAIRMENT PRESENT PSG WHEN VC < 800CC PSG IF AWAKE PaCO2 > 45 TORR PSG PREOP SCOLIOSUS SURGERY PSG MUST INCLUDE MEASURE OF ETCO2 AND PRESENCE OF REM SLEEP

ALVEOLAR HYPOVENTILATION SYNDROME A DISORDER OF PERIPHERAL OR CENTRAL CHEMORECEPTOR FUNCTION, EITHER CONGENITAL OR ACQUIRED, MANIFESTED BY DISORDERED BREATHING DURING SLEEP

ALVEOLAR HYPOVENTILATION SYNDROME PSG FOR INITIAL EVALUATION IN ALL PATIENTS PSG POST PHARMACOLOGIC INTERVENTIONS PSG IF CHANGE IN PHYSICAL STATUS

OBSTRUCTIVE SLEEP APNEA A DISORDER OF BREATHING DURING SLEEP CHARACTERIZED BY HYPOVENTILATION AS A RESULT OF PROLONGED PARTIAL UPPER AIRWAY OBSTRUCTION PUNCTUATED WITH INTERMITTENT COMPLETE OBSTRUCTION

INFANTILE APNEA NapPSG Indications: 1) BRADYCARDIA IS PRESENT 2) OBSTRUCTIVE APNEA IS SUSPECTED (if patient was premature, required CPAP, family history of OSA) 3) SYMPTOMATIC APNEA 4) DESATURATION SPECIALIZED STUDIES MAY BE REQUIRED TO EVALUATE FEEDING, FOR GER OR TO ASSESS IN CARSEAT

OBSTRUCTIVE SLEEP APNEA ADULT VS CHILD 1. FRANK OBSTRUCTIVE EPISODES MAY BE BRIEF OR ABSENT 2. PARTIAL OBSTRUCTION WITH PaCO2>45 TORR MOST COMMON FINDING 3. SLEEP DISRUPTION VERY COMMON 4. "MINIMAL" SLEEP ABNORMALITIES HAVE GREATER SIGNIFICANCE

PSG VS T&A SNORING VOLUME AND AMOUNT OF LYMPHOID TISSUE PRESENT DOES NOT DISTINGUISH PRIMARY FROM PATHOLOGIC SNORING RISKS AND COST OF SURGERY AND ANESTHESIA ARE SIGNIFICANT SEVERELY AFFECTED PATIENTS MAY REQUIRE CLOSER POST-OP OBSERVATION T & A MAY NOT BE CURATIVE

CARDIOPULMONARY POLYSOMNOGRAPHY PERSONNEL, TECHNOLOGY, METHODS DIRECTOR: PEDIATRICIAN TRAINED IN LUNG DISEASE & SLEEP MEDICINE PERSONNEL: EXPERIENCE W CHILDREN OF ALL AGES & CERTIFIED IN PCPR SETTING: AGE APPROPRIATE & NON- THREATENING, ACCOMODATIONS FOR PARENT TIMING: OVERNIGHT, NATURAL

CARDIOPULMONARY POLYSOMNOGRAPHY REPEAT PSG RECOMMENDED: CHILDREN UNDER 2 YEARS OF AGE. CHILDREN W SNORING 6-8 WKS S/P T& A CHILDREN W CRANIOFACIAL ABNOMALITIES OBESE CHILDREN S/P T&A OR WEIGHT REDUCTION

CARDIOPULMONARY POLYSOMNOGRAPHY MINIMUM MEASUREMENTS REQUIRED SLEEP STAGING EKG NASAL & ORAL AIRFLOW, ETCO2 O2 SATURATION W OXIMETRY PULSE SIGNAL AUDIOVIDEO RECOMMENDED

CARDIOPULMONARY POLYSOMNOGRAPHY SCORING CENTRAL APNEA: ALL > 20 SEC; CA > 20 SEC IF ASSC W BRADY OR DESAT > 4% PERIODIC BREATHING: DURATION AS %TST, SLEEP STAGE & EFFECT ON HR & O2 OBSTRUCTIVE APNEA: OA > 2 MISSED BREATHS, ASSC DESAT, SLEEP STAGE, OA/TST

CARDIOPULMONARY POLYSOMNOGRAPHY SCORING, CONT HYPOVENTILATION: OBSTRUCTIVE -- ETCO2 >45 TORR ASSC W PARADOXICAL BREATHING NON-OBSTRUCTIVE -- ETCO2 >45 TORR ASSC W IN-PHASE RESP MOVEMENTS

CARDIOPULMONARY POLYSOMNOGRAPHY SCORING, CONT OXYGENATION: SaO2 4% CARDIAC: RATE, RHYTHM & ASSOCIATIONS BEHAVIOR: POSITION, AROUSALS & MOVEMENTS