The Importance of Pediatric Polysomnography
Sleep plays a critical role in the early stages of development in children. It is important to focus not only on the quantity of sleep received but also the quality. While the methods of measuring and evaluating sleep quality are similar to that of adults, there are differences that sleep technologists must consider when testing pediatric patients.
What Is Pediatric Polysomnography?
Polysomnography is an elaborate diagnostic test that is composed of numerous data-collecting sensors simultaneously working toward identifying varied sleep disorders in all age groups. The pediatric patient age range spans from birth to the age of 18. While all pediatric patients come with their own sets of challenges, the toddler category — patients ranging from one to five years — are typically the most challenging to test.
Breakdown of Pediatric Age Classifications:
- Newborn (0 to 2 months)
- Infant (3 to 12 months)
- Toddler (1 to 2 years of age)
- Preschool (3 to 5 years of age)
- School Age (6 to 12 years of age)
- Adolescent (13 to 18 years of age)
Sleep Recommendation for Pediatric Patients
According to the National Sleep Foundation’s recommendation, pediatric patients require more sleep compared to adults in order to achieve optimal health and well-being. Daily sleep recommendations by age range are as follows:
- Infants 4-12 months: 12-16 hours including naps
- Children age 1-2 years: 11-14 hours including naps
- Children age 3-5 years: 10-13 hours including naps
- Teenagers age 13-18 years: 8-10 hours
Brain and Sleep Development
As mentioned in Module 1 of the AAST Advanced Pediatrics Module Series, in pediatric patients brainwave patterns differ both in morphology and reactive response. Electroencephalogram (EEG) patterns develop over time and with age, and change rapidly, with the most rapid changes occurring within the neonatal period where patterns evolve on a weekly basis. Therefore, it’s important for sleep technologists to know what EEG pattern to expect based on age.
Waveforms Developing Over Time:
- Sleep spindles
- Predictable sleep-wake patterns
Factors sleep technologists must consider while scoring a polysomnography (PSG) in pediatric patients include:
- Sleep latency
- Percentage of time spent in stages N1 and N2 of sleep
- Wake after sleep onset (WASO) increase
- Total sleep time increase
- Sleep efficiency, percentage of slow and rapid eye movement (REM) sleep
- REM latency decrease
Indicators for Pediatric PSG
The following are common indicators for PSG in pediatric patients:
- Respiratory issues
- Congenital central alveolar hypoventilation syndrome (CCHS)
- Sleep-related hyperventilation due to muscular disorders or chest wall deformities
- Primary sleep apnea
- An apparent life-threatening event (ALTE)
Different Types of Questionnaires Used
The Pediatric Sleep Questionnaire (PSQ) is the primary pediatric questionnaire used in sleep-related breathing disorder (SRBD) research in pediatric patients. The questionnaire reviews 22 symptom items. It is not typically used in clinical practice, but many simplified questionnaires are used in sleep centers to evaluate common symptoms of obstructive sleep apnea (OSA).
Another type of questionnaire, known as BEARS, is a simplified pediatric sleep questionnaire. Breaking down the acronym this questionnaire assesses five items, bedtime issues (B), excessive daytime sleepiness (E), night awakenings (A), regularity and duration of sleep (R), and snoring (S).
Importance of Communication
When working with pediatric patients, communication is vital and it’s important that sleep technologists communicate with the patient and their parents directly. While conducting testing, also be mindful of your body language, as pediatric patients become very observant of a medical professionals’ body language. It’s also imperative that findings and outcomes of sleep studies are communicated back to the patient’s physician.
The practice of good sleep hygiene is a key factor in the growth and health of pediatric patients. Through active education on this topic, constant communication and a thorough understanding of pediatric sleep, sleep technologists can actively assess and assist with management of sleep issues and disorders affecting the pediatric population.