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What Are the Factors Affecting Total Sleep Time During Video Polysomnography in Infants?
Grace R Paul1, Don Hayes2, Dmitry Tumin3
1Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Infant polysomnography (PSG) interpretation is accurate with less than 4 hours of total sleep time (TST). Shorter TST in infants is linked to age, medical complexity, and higher apnea-hypopnea index (AHI).
Area of Science:
- Neonatal Medicine
- Pediatric Sleep Medicine
- Clinical Neurophysiology
Background:
- Infant polysomnography (PSG) is crucial for diagnosing sleep-related breathing disorders.
- Total sleep time (TST) is a key metric in PSG interpretation.
- Factors influencing TST in infants require further investigation.
Purpose of the Study:
- To identify factors affecting TST during infant PSG.
- To determine if TST < 4 hours is sufficient for accurate PSG interpretation.
- To assess the relationship between TST and apnea-hypopnea index (AHI) in infants.
Main Methods:
- Retrospective review of 242 infant PSGs (infants < 6 months).
- Analysis of factors including infant age, post-menstrual age (PMA), medical complexity, study timing, and presence of nasal tubes.
- Examination of AHI in relation to TST, particularly in infants with TST < 4 hours.
Main Results:
- Greater TST was associated with nocturnal studies, older chronological and post-menstrual ages, and absence of medical complexity.
- Nasogastric/impedance tubes significantly reduced TST.
- Elevated AHIs were observed even with TST < 4 hours, suggesting sufficiency for interpretation.
Conclusions:
- Infant age, medical complexity, and study logistics (time of day, location) influence TST during PSG.
- TST < 4 hours can be adequate for identifying significant AHI, enabling physician interpretation.
- Understanding factors affecting TST can optimize PSG protocols and interpretation.
Objective:
The aim of the study is to investigate factors affecting total sleep time (TST) during infant polysomnography (PSG) and assess if <4 hours of TST is sufficient for accurate interpretation.
Study Design:
Overall, 242 PSGs performed in 194 infants <6 months of chronological age between March 2013 and December 2015 were reviewed to identify factors that affect TST, including age of infant, location and timing of study, presence of medical complexity, and presence of nasal tubes. A continuum of apnea-hypopnea index (AHI) in relation to TST was reviewed. Data were examined in infants who had TST <4 hours and low AHI.
Results:
Greater TST (p < 0.001) was noted among infants during nocturnal PSGs, at older chronological and post-menstrual ages, and without medical complexity. The presence of nasogastric/impedance probes reduced TST (p = 0.002). Elevated AHIs were identified even in PSGs with TST <4 hours. Short TST may have affected interpretation and delayed initial management in one infant without any inadvertent complications.
Conclusion:
Clinical factors such as PMA and medical complexity, and potentially modifiable factors such as time of day and location of study appeared to affect TST during infant PSGs. TST < 4 hours can be sufficient to identify high AHI allowing physician interpretation.
Key Points:
· Less than 4 hours of TST is enough for interpretation of infant polysomnography.. · Shorter TST appears related to infant age, medical complexity, and higher apnea-hypopnea index.. · Modifiable factors seen with higher TST were time of day, environment, and presence of nasal tubes..
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