572 Utility of Split Night Polysomnograms in Children. (3rd May 2021)

• Record Type: Journal Article
• Authors: Rao, Harish
• Is Part Of: Sleep. Volume 44(2021)Supplement 2
• Page Start: A225
• Page End: A226
• Publication Date: 2021-05-03
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsab072.570
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Overnight in-lab polysomnograms (PSG) are the gold standard for diagnosis of sleep disordered breathing in children. As the wait time for adenotonsillectomy (T & A) at our institution was several months, we implemented split night PSGs with positive airway pressure (PAP) during the initial diagnostic PSG if AHI>30 (Emergency SNPSG). Planned SNPSG were performed on children who are undergoing PSG after T & A, eliminating follow-up titration PSG if the PSG is positive for OSA (residual AHI>10/hour). We present data on the outcomes of the SNPSG. Methods: Retrospective chart review of consecutive SNPSGs done over last 2 years at our institution was performed. Data on SNPSGs (planned or emergency), age, sex, diagnostic study duration, diagnostic study AHI, PAP pressure and subsequent PAP adherence were collected. Data on sleep efficiency, arousal, sleep architecture, REM sleep were compared between diagnostic and titration part of the SNPSG. Study was considered successful if patient was able to tolerate PAP during titration and also if adherent to PAP at follow up. Results: 48 studies met the criteria for SNPSG, with 60% of SNPSG being emergency SNPSG with AHI>30. Our cohort's age ranged from 2–18 years (median age 8 years); 33 were males. Majority of the emergency SNPSG were in younger children (80% < 5 years), 75% of them continued to use PAP (mostly CPAP) until T & A with wait time being more than 3 months. Average wait time for T & A was 4 months. 25% of patients continued to use PAP following T & A as residual AHI was >10/hour. 98% of the patients were able to tolerate PAP during titration section with restoration of sleep architecture including REM with reduction in AHI, arousals and improved sleep efficiency. Bilevel PAP was used in 10% of patients in mostly planned SNPSG. Conclusion: SNPSG can be implemented with fair degree of success during initial PSG with PAP used until T & A is performed. Planned SNPSG are also useful with residual severe OSA eliminating need for subsequent titration study. When indicated, 75% of our cohort continued to use PAP with fair adherence (>70% nightly use) following SNPSG. Support (if any):