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Non-respiratory indications for polysomnography and related procedures in children: an evidence-based review
Suresh Kotagal1, Cynthia D Nichols, Madeleine M Grigg-Damberger
1Mayo Clinic, Rochester, MN, USA.
Insights
Polysomnography is valuable for diagnosing pediatric non-respiratory sleep disorders like hypersomnias and parasomnias. It aids in evaluating excessive sleepiness and specific movement disorders, especially when obstructive sleep apnea is suspected.
Area of Science:
- Pediatric Sleep Medicine
- Neurology
- Clinical Diagnostics
Background:
- Non-respiratory sleep disorders in children encompass a range of conditions including hypersomnias, parasomnias, and sleep-related movement disorders.
- Accurate diagnosis is crucial for effective management and improving quality of life in affected children.
- Polysomnography (PSG) is a key diagnostic tool in sleep medicine, but its specific utility for non-respiratory disorders requires careful consideration.
Purpose of the Study:
- To systematically review the literature on the utility of polysomnography (PSG) for evaluating non-respiratory sleep disorders in children.
- To provide evidence-based guidance on the appropriate use of PSG in pediatric sleep evaluations.
- To assess PSG's role in diagnosing conditions such as hypersomnias, parasomnias, and sleep-related movement disorders.
Main Methods:
- A systematic literature review was conducted by a task force of pediatric sleep medicine experts.
- Seventy-six relevant papers were identified and graded for their evidence level.
- The review focused on the application of PSG in diagnosing non-respiratory sleep disorders in pediatric populations.
Main Results:
- Polysomnography combined with the multiple sleep latency test objectively quantifies sleepiness in disorders of excessive somnolence, requiring interpretation considering pubertal stage and sleep patterns.
- PSG is indicated for children with parasomnias or sleep-related movement disorders if obstructive sleep apnea (OSA) is suspected.
- PSG can be helpful for evaluating restless legs syndrome (RLS) and suspected periodic limb movement disorder (PLMD), but is not routinely indicated for enuresis unless OSA is likely.
Conclusions:
- Polysomnography should be integrated into comprehensive sleep evaluations for children with non-respiratory sleep disorders under specific circumstances.
- Its use is particularly recommended to detail event nature or when there is a significant suspicion of obstructive sleep apnea (OSA).
- This approach ensures targeted diagnostic utility for complex pediatric sleep conditions.
Objective:
This evidence-based review provides a systematic and comprehensive review of the literature regarding the utility of polysomnography for the evaluation of non-respiratory sleep disorders in children including hypersomnias, parasomnias, sleep-related movement disorders, and sleep in other special populations.
Methods:
A task force of pediatric sleep medicine experts performed a systematic review of the literature regarding the use of polysomnography for non-respiratory sleep disorders in children. They identified and graded 76 papers as evidence.
Results:
The main results include (1) polysomnography combined with the multiple sleep latency test is useful for evaluating disorders of excessive somnolence to objectively quantify sleepiness. The results have to be interpreted with consideration of the pubertal stage and regularity of the sleep patterns of the child; (2) polysomnography is indicated in children with parasomnias or sleep related movement disorders who have a high likelihood of having obstructive sleep apnea (OSA); (3) polysomnography is not routinely indicated in children with enuresis unless there is a high likelihood of OSA; (4) polysomnography can be helpful in evaluating children with restless legs syndrome (RLS) and when periodic limb movement disorder (PLMD) is suspected.
Conclusions:
These findings suggest that, in children with non-respiratory sleep disorders, polysomnography should be a part of a comprehensive sleep evaluation in selected circumstances to determine the nature of the events in more detail or when the suspicion of OSA is relatively high.
