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Normal polysomnographic values for children and adolescents
C L Marcus1, K J Omlin, D J Basinki
1Division of Neonatology and Pediatric Pulmonology, Children's Hospital of Los Angeles, University of Southern California School of Medicine.
Insights
Normal polysomnography values for children and adolescents with sleep-disordered breathing are now established. Pediatric sleep study results differ from adult norms, providing new criteria for diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Clinical Neurophysiology
Background:
- Polysomnography (PSG) is standard for diagnosing pediatric sleep-disordered breathing.
- Established normal PSG values for children and adolescents are lacking.
- This gap hinders accurate diagnosis and management in pediatric populations.
Purpose of the Study:
- To establish normal overnight polysomnography (PSG) values in a cohort of healthy children and adolescents.
- To define normative criteria for pediatric sleep studies.
- To compare pediatric PSG findings with established adult norms.
Main Methods:
- Overnight polysomnography was conducted on 50 healthy children and adolescents (age range 1.1-17.4 years).
- Monitored parameters included chest wall motion, ECG, airflow, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram.
- Data analysis focused on respiratory events (apneas, hypopneas), PETCO2 levels, and SaO2 variations.
Main Results:
- Most children had minimal or no obstructive apneas; none exceeded 10 seconds.
- Central apneas (>= 10s) occurred in 30% of children, with one associated with SaO2 < 90%.
- Peak PETCO2 averaged 46 mmHg, with hypoventilation (PETCO2 > 45 mmHg) occurring in 7% of total sleep time; SaO2 nadir was 96%.
Conclusions:
- Pediatric polysomnography results significantly differ from adult norms.
- Established normal values provide essential reference points for diagnosing pediatric sleep-disordered breathing.
- Recommendations for normal pediatric PSG criteria are proposed based on these findings.
Abstract:
Although polysomnography is routinely performed to evaluate children and adolescents with sleep-disordered breathing, normal polysomnographic values for the pediatric age group have not yet been established. We therefore performed overnight polysomnography in 50 normal children and adolescents (mean age 9.7 +/- 4.6 SD yr, range 1.1 to 17.4 yr). Of the children 56% were male. Chest wall motion, ECG, oronasal airflow, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram were monitored. Children had 0.1 +/- 0.5 (range 0 to 3.1) obstructive apneas per hour of total sleep time, with only 18% of children having any obstructive apneas. No child had obstructive apneas > 10 s in duration. Of the children 30% had central apneas > or = 10 s in duration, and one child had a central apnea associated with SaO2 < 90%. Peak PETCO2 was 46 +/- 4 mm Hg (range 38 to 53 mm Hg), and hypoventilation (PETCO2 > 45 mm Hg) occurred for 7 +/- 19% total sleep time (range 0 to 91%). The SaO2 nadir was 96 +/- 2% (range 89 to 98%), with only one child desaturating below 90% in association with a central apnea. We conclude that polysomnographic results in the pediatric age group differ from those in adults. Recommendations for normal polysomnographic criteria are given.