Pediatric Polysomnography: Time to Rethink?

PROGRAM DESCRIPTION: Currently, in-lab, monitored polysomnography (PSG) is the only FDA-approved test for obstructive sleep apnea in children. However, many children at risk for OSA have developmental and behavioral challenges that complicate in-lab testing. Furthermore, timely access to in-lab pediatric studies is not universal and is becoming increasingly scarce. This begs the question: is it time to re-think alternatives to the in-lab PSG?

Results from the recently-published PATS trial question reliance on PSG to “rule out” clinically significant sleep disordered breathing. This begs the question: is it time to re-think whether to offer adenotonsillectomy when a child has a “negative” sleep study?

Pediatric sleep studies are scored differently than adult studies and the criteria that define OSA as mild, moderate are applied similarly to infants, school-age children, and adolescents. However, recent publications have highlighted differences in normative data across the age spectrum and suggest that PSG data in a 10-month-old is very different from a 10-year-old. This begs the question: should we re-think how we interpret PSG across the age spectrum?

In this session, pediatric otolaryngologists and sleep medicine experts from diverse geographic locations will share their experience with polysomnography in the pediatric population. Panelists will debate the pros and cons of the in-lab studies and their alternatives. Cases will highlight clinical controversies that include evolving indications for PSG in children, interpretation of PSG across the pediatric age span, and concerns unique to a population with a high prevalence of neurosensory processing disorders.

OUTCOME OBJECTIVE 1: Confidently interpret polysomnography reports across the pediatric age spectrum (from infants to adolescents)

OUTCOME OBJECTIVE 2: Understand the evolving indications for polysomnography in light of recent clinical trial data, and understand the role of polysomnography in clinical decision-making

OUTCOME OBJECTIVE 3: Describe emerging technologies and alternatives to in-lab polysomnography for evaluation of sleep disordered breathing in children

BACKGROUND STATEMENT: This proposal is in response to program gap identified by the planning committee under sleep medicine: Diagnostic testing for OSA, including home polysomnograms. Access to PSG is limited, which creates delays in care, barriers to care, and contributes to health disparities in children.

Comprehensive Otolaryngology Track Statement :