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

Abstract

Objective: 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.

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

Results: 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.

Conclusions: 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.