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Pediatric Sleep Disorders Workup

  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Apr 11, 2014
 

Sleep Studies

Sleep laboratory studies are very helpful when indicated, but most common pediatric sleep problems do not require formal sleep laboratory testing. Most sleep problems resolve with behavioral treatments. Overnight polysomnography (PSG) and next-day multiple sleep latency tests (MSLTs) represent the most commonly used sleep studies. Clinical suspicion of any of the following disorders should prompt referral for sleep studies:

  • Sleep-related seizurelike activity
  • Sleep-related gastroesophageal reflux
  • Nighttime asthma or persistent cough
  • Attention deficit hyperactivity disorder (ADHD) [13] or Tourette syndrome associated with restless sleep and disrupted daytime functioning
  • Restless legs syndrome (RLS) and periodic limb movement during sleep (PLMS) – Both are relatively common in these patients
  • Recurrent rapid eye movement (REM) sleep behaviors
  • Severe bruxism
  • Snoring and hypopnea or apnea
  • Recalcitrant or unexplained and daytime somnolence
  • Suspected narcolepsy

MSLTs aid in clarifying unexplained excessive daytime sleepiness and narcolepsy symptoms but must be performed after the individual has stopped all psychotropic medications and has 2 weeks of sufficient sleep time.

Recent review of literature has generated practice parameters for PSG and MSLT testing in children based on the strength of evidence for respiratory[14] and nonrespiratory indications.[4] The articles define the "standard" recommendation as being generally accepted patient-care strategy based on overwhelming prospective studies and/or well-designed retrospective studies. "Guideline" recommendations are based on moderate clinical certainty, some number of well-controlled prospective and/or well-designed retrospective studies or a consensus of retrospective studies. The "option" recommendation reflects uncertain clinical use and inconclusive/conflicting evidence or expert opinion.

For respiratory indications, PSG is a standard indication for obstructive sleep apnea evaluation, following adenotonsillectomy for obstructive sleep apnea syndrome (OSAS), craniofacial anomalies that disrupt the upper airway, and neurological disorders (trisomy 21, Prader-Willi syndrome, and myelomeningocele). PSG should be standard in the titration of positive airway pressure in OSAS. Guideline recommendations are present for use of PSG in the assessment of congenital central alveolar hypoventilation syndrome, sleep-related hypoventilation related to neuromuscular disorders or chest wall deformities, and selected cases of primary sleep apnea of infancy. In infants with clinical evidence of sleep-related breathing disorder, PSG is a guideline recommendation for those with an apparent life-threatening event. In children being considered for adenotonsillectomy to treat obstructive sleep apnea, PSG is also only a guideline recommendation.

For nonrespiratory indications, standard use of PSG is indicated in children suspected of having periodic limb movement disorder (or RLS). MSLT preceded by nocturnal PSG is indicated for children being evaluated for narcolepsy. In children with non-REM (NREM) parasomnias, epilepsy, or nocturnal enuresis, PSG is a guideline recommendation if there is suspicion of sleep-disordered breathing or periodic limb movement disorder. MSLT preceded by nocturnal PSG is an option in children suspected of having hypersomnia for causes other than narcolepsy. PSG with an expanded EEG montage is an option in children to confirm a diagnosis of an atypical or potentially injurious parasomnia or to differentiate parasomnia from sleep-related epilepsy. PSG is an option for evaluating children suspected of having RLS.

 
 
Contributor Information and Disclosures
Author

Sufen Chiu, MD, PhD Assistant Clinical Professor (Volunteer Faculty), University of California, Davis, School of Medicine; Staff Physician, Mercy Medical Group

Sufen Chiu, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychiatric Association, California Medical Association, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Guy K Palmes, MD Assistant Professor, Program Director, Department of Psychiatry, Section of Child and Adolescent Psychiatry, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Dennis A Nutter, Jr, MD President and Director, North Georgia Neuropsychiatry, PC

Dennis A Nutter, Jr, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Chet Johnson, MD Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Benyam Tegene, MD Fellow, Department of Psychiatry, Wake Forest University Baptist Medical Center

Benyam Tegene, MD is a member of the following medical societies: American Medical Association and American Psychiatric Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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