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Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center
Kanokkarn Sunkonkit1,2, Mohammed Alzaid1,3, Lena Xiao1
1Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Inpatient polysomnography (PSG) is crucial for diagnosing pediatric sleep-disordered breathing (SDB), guiding ventilation and surgical interventions. This study analyzed PSG indications and outcomes in children, revealing its diagnostic value.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Polysomnography (PSG) is the standard for diagnosing pediatric sleep-disordered breathing (SDB).
- Limited literature exists on indications and clinical impact of inpatient PSGs in children.
Purpose of the Study:
- To determine indications, results, and outcomes for pediatric inpatient PSGs.
- To characterize the role of inpatient PSG in clinical decision-making for children.
Main Methods:
- Retrospective review of children (0-18 years) undergoing inpatient PSG from July 2018 to July 2021.
- Analysis of baseline characteristics, indications for PSG, and subsequent management.
- Descriptive statistics used to characterize data.
Main Results:
- Eighty-eight PSGs were performed in 75 children; 45.3% indicated for ventilation initiation/titration.
- 64% of children had multiple complex chronic conditions (CCCs).
- 90% of baseline PSGs revealed clinically significant SDB, most commonly obstructive sleep apnea (OSA). Management included respiratory technology (88.9%) and surgery (31.5%).
Conclusions:
- Inpatient PSG is a vital diagnostic tool for pediatric SDB, leading to targeted medical and surgical management.
- Further multicenter studies are needed to establish evidence-based clinical practice guidelines for inpatient PSG indications.
Background:
Polysomnography (PSG) is the gold standard for the diagnosis of pediatric sleep-disordered breathing (SDB). However, the literature characterizing the indications for inpatient PSGs and the impact on clinical decision-making is limited.
Objective:
To determine the indications, results, and outcomes for children undergoing inpatient PSGs at our institution.
Methods:
We performed a retrospective review of children aged 0-18 years who underwent inpatient diagnostic PSGs between July 2018 and July 2021 at SickKids, Toronto, Canada. Baseline characteristics, indications, and management were reviewed and characterized by descriptive statistics.
Results:
Eighty-eight inpatient PSGs were performed in 75 children (male 62.7%). Median (interquartile range) age and body mass index z-score were 1.5 (0.2, 10.8) years and 0.27 (-1.58, 2.66), respectively. The most common indication for inpatient PSG was initiation and titration of ventilation (n = 34/75, 45.3%). Of the 75 children, 48 (64%) had multiple complex chronic conditions (CCCs). Sixty children (80%) underwent a baseline PSG for either the entire night or a portion of the night. Of these studies, 54 (90%) had clinically significant SDB of which isolated obstructive sleep apnea (OSA; 17/60, 28.3%) was the most common. The following management was undertaken for the 54 patients with SDB; respiratory technology (88.9%), surgical intervention (31.5%), positional therapy (1.9%), intranasal steroids (3.7%), and no further intervention (5.6%), respectively.
Conclusions:
Our study highlights that inpatient PSG was an important diagnostic tool resulting in directed medical and surgical management. Future multicenter studies are needed to compare indications for inpatient PSGs across institutions to develop evidence-based clinical practice guidelines.
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