Suspected pediatric sleep disordered breathing - when do we perform polysomnography?

Snoring is common in children and diagnosing sleep disordered breathing (SDB) and assessing its severity is unreliable without polysomnography (PSG), a costly procedure that is not always readily available. Our objective was to identify those factors that influence the decision to refer children for PSG.

A retrospective cohort study of 1267 children aged 0-16 years with suspected SDB and/or adenotonsillar hypertrophy.

A total of 212 children (16.5%) underwent PSG. The likelihood of PSG being performed increased with age (OR 1.14, p <.001, 95% CI 1.08-1.20), male sex (OR 1.72, p 0.008, 95% CI 1.15-2.58), and certain OSA symptoms. Children with a moderate (OR 3.82, p <.001, 95% CI 2.66-5.57) or severe comorbidity (OR 9.84, p <.001, 95% CI 6.48-14.92) were more likely to undergo PSG than healthy individuals. Children referred from pediatric specialties were also more likely to undergo PSG (OR 15.00, p <.001, 95% CI 9.76-23.05) than children from primary health care, whereas children referred from a dentist were less likely to do so (OR 0.12, p 0.034, 95% CI 0.02-0.85). Children who underwent PSG were more likely to be treated conservatively than those diagnosed clinically.

The decision to refer children for PSG is susceptible to subjectivity and the factors influencing it are likely broadly generalizable. Therefore, a guideline for referring a child with suspected SDB for PSG is needed. This would not only standardize the SDB diagnostic pathway, but also potentially reduce the need for further follow-up or surgeries.