Telehealth-supported level 2 pediatric home polysomnography

The gold standard for diagnosis of pediatric obstructive sleep apnea (OSA) is level 1 polysomnography (PSG). At our centre, some children are selected for unattended level 2 home sleep apnea testing (HSAT) with telehealth support, and we sought to review this home service.

A retrospective audit was conducted from 2013 to 2020. All level 2 HSAT reports in children aged 5-18 years referred for suspected OSA were analyzed. American Academy of Sleep Medicine-compliant portable PSG acquisition equipment with electroencephalogram was used. The primary outcome was the proportion of technically successful tests achieved, and of these, the percentage with potential underestimation of diagnostic category. Secondary outcomes included sleep quality and parental acceptance by nonvalidated service-specific questionnaire. Data were analyzed using descriptive and inferential statistics. χ² tests were used for categorical variables.

There were 233 (139 male, 59.6%) patients studied between 2013 and 2020 (7 years). The mean age was 10.8 (standard deviation 3.6) years. Sixty-seven patients (28.8%) had comorbidities. Technically successful studies were obtained in almost 90% (209/233) and failed studies occurred in just over 10% (24/233). One failed study still achieved a diagnosis. There was no significant difference between failed studies set up by hospital-in-the-home nurses compared with sleep scientists (P = .2). Overall, an accurate diagnosis was made in 80% (167/209) of patients, with potential for underestimation in 20% (42/209). Six hours or more of sleep was obtained in 89.5%. Parental questionnaires revealed 89.3% perceived high-level care, 91% perceived increased convenience, and 76% perceived good/excellent telehealth support.

Telehealth-supported pediatric HSAT achieves technical success in almost 90% of patients investigated for OSA, with 89.5% achieving ≥ 6 hours sleep duration and excellent family acceptability.

Griffiths A, Mukushi A, Adams A-M. Telehealth-supported level 2 pediatric home polysomnography. J Clin Sleep Med. 2022;18(7):1815-1821.