Role of a sleep study in pediatric Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome(OSAS) is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea). This disrupts normal ventilation during sleep & normal sleep pattern. Prevalence of OSAS is  1% to 5%. Its is different from a habitual snoring, which also has a prevalence of 3% to 12%.

On a clinical history and examination alone, it is difficult to confirm or rule out a diagnosis of OSA in children. Signs and symptoms not only have a poor sensitivity & specificity but they poorly predict disease severity. If a child or adolescent snores on a regular basis and has any of the complaints or findings should undergo sleep study or Polysomnography.

HistoryPhysical Examination
Frequent snoring (≥3 nights / week)Underweight or overweight
Labored breathing during sleepTonsillar hypertrophy
Gasps or snorting noises /observed episodes of apneaAdenoidal facies
Sleep enuresis (especially secondary enuresis)Micrognathia /Retrognathia
Sleeping in a seated position or with the neck hyperextendedHigh-arched palate
CyanosisFailure to thrive
Headaches on awakeningHypertension
Daytime sleepinessUnderweight
Attention-deficit/ hyperactivity disorderOverweight

Other Respiratory indications of sleep study

  • Suspected sleep Apnea 
  • Adenotonsillar hypertrophy and/or 
  • Obesity
  • Complicated Sleep Apnea
  • Neuromusular Disorders
  • Suspected Noctural Hypoventialtion
  • Oxygen Titration Studies
  • Infants: CCHS, ALTE, GERD, central sleep apnea
  • Syndromes associated with OSA
    • Craniofacial syndromes: Apert, Crouzon, Down’s syndrome, Obesity syndromes, Prader Willi, Pierre Robin sequence
  • Other high risk situations like CLD, Sickle cell disease, MPS, Cleft palate, Choanal stenosis, Tracheo-bronchomalacia

POST PIC CREDITS Dr Ankit Parakh’s website

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