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Comparison of nap and overnight polysomnography in children
C L Marcus1, T G Keens, S L Ward
1Division of Neonatology and Pediatric Pulmonology, Childrens Hospital Los Angeles, University of Southern California School of Medicine 90027.
Insights
Daytime nap polysomnography can screen for pediatric sleep-disordered breathing, but overnight polysomnography is still needed for definitive diagnosis. Nap studies, even with sedation, may underestimate breathing issues.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
Background:
- Overnight polysomnography is the gold standard for diagnosing sleep-disordered breathing (SDB) in children.
- Limited resources for pediatric polysomnography necessitate a reliable screening test.
Purpose of the Study:
- To compare the efficacy of 1-hour daytime nap polysomnography with overnight polysomnography for diagnosing SDB in children.
- To evaluate nap polysomnography as a potential screening tool.
Main Methods:
- 40 children with SDB underwent both nap and overnight polysomnography.
- Monitored parameters included chest wall motion, ECG, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram.
- 76% of children received chloral hydrate for sedation during nap studies.
Main Results:
- Nap polysomnography demonstrated 74% sensitivity and 100% specificity for SDB.
- Overnight polysomnography revealed significantly more obstructive apnea and desaturation events (SaO2 < 90%).
- Despite sedation, nap polysomnography underestimated SDB severity compared to overnight studies.
Conclusions:
- Nap polysomnography can identify SDB cases confirmed by overnight polysomnography.
- Nap polysomnography may serve as an effective screening method for pediatric SDB.
- Overnight polysomnography remains essential for inconclusive nap study results; chloral hydrate can aid nap induction.
Abstract:
Overnight polysomnography is the "gold standard" for diagnosing sleep-disordered breathing. However, the limited number of resources for pediatric polysomnography make the availability of a screening test for sleep-disordered breathing highly desirable. Therefore, we compared 1 hour daytime nap polysomnography to overnight polysomnography in 40 children [mean age, 5.4 +/- 0.8 (SE) years] with sleep-disordered breathing; 76% of children were sedated with chloral hydrate for nap polysomnography; none was sedated for overnight polysomnography. Studies were done 26 +/- 4 days apart. Chest wall motion, ECG, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram were monitored. Nap studies had a sensitivity of 74%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 17% in predicting sleep-disordered breathing. Significantly more children had obstructive apnea and desaturation (SaO2 less than 90%) during overnight polysomnography. The peak PETCO2 and the SaO2 nadir were significantly worse during overnight polysomnography. However, the percentage of time during which abnormalities were manifested did not differ between nap and overnight polysomnography. Despite the use of sedation, nap polysomnography underestimated sleep-disordered breathing. We conclude that sleep-disordered breathing detected by nap polysomnography is always confirmed by overnight polysomnography and speculate that nap polysomnography may be an effective screening method for sleep-disordered breathing. However, overnight polysomnography should be performed if nap polysomnography is inconclusive. Chloral hydrate may be used effectively to facilitate sleep for nap polysomnography in children.