Full-night versus 4 h evening polysomnography in children less than 2 years of age

Objective: Pediatric polysomnogaphy (PSG) is associated with significant burden in terms of personnel time, resource use, and patient/family discomfort. We hypothesized that 4-h abbreviated PSG may be a suitable alternative to full-night PSG in children 24 months of age and younger. Methods: PSG results from the first 4-h were compared to the full-length studies from 105 children. Outcomes included total, obstructive, and central apnea indices. Sleep disordered breathing (SDB) was defined as an apnea-hypopnea index (AHI) >1.5 events/h and obstructive sleep apnea (OSA) was defined as an obstructive AHI > 1.5 events/h. Cutoffs for central apneas were 3 events/h for subjects >6 months of age and 10 events/h for subjects <= 6 months of age. Results: All but one subject had abnormal SDB by the full-night PSG and all individuals had at least one REM period in the first 4 h of sleep. Mean oxygen saturations and end-tidal CO2, did not significantly differ between full-night and 4-h PSG. 4-h PSG showed high sensitivity for total AHI (100% for <= 6 months and 92.9% for >6 months respectively), obstructive AHI (97.9%; 91.1% respectively), and central apnea index (100%; 72.2% respectively). Agreement was lower for those with lower AHI. Conclusions: The high prevalence of SDB observed suggests that the goals of PSG in this age group at our center may be to determine the type and severity of SDB rather than presence or absence. The high sensitivity between full-night and 4-h PSG supports the use of 4-h PSG in children 24 months and under, especially those <= 6 months of age. (C) 2012 Elsevier B. V. All rights reserved.