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Published on: January 26, 2019
Polysomnographic values in children 2-9 years old: additional data and review of the literature
Nadav Traeger1, Brian Schultz, Avrum N Pollock
1Division of Pulmonary Medicine and Sleep Disorders Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Insights
This study establishes normal sleep parameters for children aged 2-9, finding few respiratory events but noting variations in paradoxical breathing measurement. These findings are crucial for diagnosing sleep disorders in pediatric populations.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Neurology
Background:
- Establishing normal pediatric polysomnography parameters is vital for clinical diagnosis and research.
- Understanding sleep architecture and respiratory events in children is essential for identifying sleep disorders.
Purpose of the Study:
- To define normal polysomnographic parameters in children aged 2-9 years, a peak age for obstructive sleep apnea syndrome.
- To describe respiratory events, paradoxical breathing, periodic limb movements, and sleep architecture in this pediatric cohort.
Main Methods:
- Retrospective cross-sectional analysis of a prospective cohort of 66 children (2-9 years old).
- Standard polysomnography (PSG) including respiratory effort monitoring with different technologies.
- Screening via questionnaire followed by PSG.
Main Results:
- Sleep architecture: Stage 1 (4%), Stage 2 (44%), Stage 3 (10%), Stage 4 (22%), REM (21%). Arousal/awakening index: 11.2/hr.
- Respiratory events were rare: Central apnea index 0.08/hr, Obstructive apnea index 0.01/hr, Obstructive hypopnea index 0.3/hr.
- Paradoxical breathing measurement varied significantly by technology (piezo belts vs. inductive plethysmography). Baseline SpO2 was 97%, nadir 92%.
Conclusions:
- Normal polysomnographic values for sleep stages, oxygen saturation, and respiratory events were established for children aged 2-9.
- Periodic limb movements in sleep (PLMS) and arousal/awakening indices were documented.
- Measurement of paradoxical breathing is technology-dependent, highlighting the need for standardized methods in pediatric sleep studies.
Abstract:
The establishment of normal pediatric polysomnographic parameters is important for both clinical and research interests. Our objectives were to describe respiratory events, paradoxical breathing, periodic limb movements, and sleep architecture of children at the age of peak incidence of obstructive sleep apnea syndrome. We performed a retrospective cross-sectional analysis of a prospective cohort study of 66 children, 2-9 years old, at the Sleep Disorders Center at the Children's Hospital of Philadelphia. Subjects screened by questionnaire underwent a standard polysomnogram. The percent of total sleep time spent in sleep stages 1, 2, 3, 4, and rapid eye movement (REM) were 4 +/- 3%, 44 +/- 10%, 10 +/- 6%, 22 +/- 8%, and 21 +/- 6%, respectively. The arousal and awakening index was 11.2 +/- 4.3/hr. Respiratory events included a central apnea index of 0.08 +/- 0.14/hr, obstructive apnea index of 0.01 +/- 0.03/hr, and obstructive hypopnea index of 0.3 +/- 0.5/hr. The baseline arterial oxygen saturation (SpO2) was 97 +/- 1%, with a nadir of 92 +/- 3%. The index of periodic limb movements in sleep (PLMS) was 1.3 +/- 2.2/hr. Paradoxical breathing appeared significantly more frequent with piezo crystal effort belts (40 +/- 24% of epochs) than with respiratory inductive plethysmography (1.5 +/- 3% of epochs). We describe the occurrence of hypopneas during sleep, arousals and awakenings, and PLMS. We illustrate how different technologies can vary the apparent amount of paradoxical breathing. We also confirm previous data on the frequency distribution of sleep stages, SpO2, and relative rarity of respiratory events in this age group.
