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Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms

Elizabeth J Abraham1, Ashank Bains1, Batsheva R Rubin1,2

  • 1Boston University School of Medicine, Boston, MA, USA.

The Annals of Otology, Rhinology, and Laryngology
|February 5, 2021
PubMed

Insights

Nearly half of children with suspected sleep-disordered breathing had normal polysomnography results. Larger tonsils and younger age increased obstructive sleep apnea (OSA) risk, while White children had lower odds than Black children.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Respiratory Medicine

Background:

  • Obstructive sleep-disordered breathing (oSDB) is a common condition in children.
  • Diagnostic polysomnography (PSG) is a key tool for diagnosing oSDB.
  • Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) inform PSG indications.

Purpose of the Study:

  • To determine the prevalence of normal PSG results in children evaluated for oSDB.
  • To identify characteristics associated with normal PSG findings in this pediatric population.
  • To understand factors influencing obstructive sleep apnea (OSA) diagnosis in children.

Main Methods:

  • Retrospective cohort study of 456 children (ages 2-18) undergoing PSG for SDB between 2012-2018.
  • Data collected included demographics, symptom severity, and tonsil size.
  • Univariate and multivariate analyses were used to assess associations.

Main Results:

  • 44.7% of children had normal PSG results (Apnea-Hypopnea Index < 2).
  • Larger tonsil size was associated with increased odds of OSA (OR 3.18).
  • Younger children (2-3 years) and White children had lower odds of OSA compared to older children and Black children, respectively.

Conclusions:

  • A significant proportion of children evaluated for oSDB do not meet diagnostic criteria on PSG.
  • Tonsil size, age, and race are associated with OSA diagnosis in children.
  • PSG findings in children with SDB can influence management decisions, emphasizing patient-centered discussions with families.
Abstract

Keywords:
AAO-HNSF guidelinesdiagnostic polysomnographyelective polysomnographypatient safetypediatric obstructive sleep apneasleep disordered breathing

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