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We read with interest the article by Leong et al. on the use of polysomnography (PSG) in children (Leong et al. 2019), covering indications for PSG, along with limitations of oximetry, and clearly outlining how to undertake and interpret polysomnography in paediatric patients. It briefly discusses limited channel recordings (respiratory polygraphy, RP) and concludes that this ‘is not standard practice’.
In many paediatric centres RP is standard practice, and routinely used for assessment of sleep-disordered breathing (SDB) in children, with the most common diagnosis being obstructive sleep apnoea (OSA).
In a recent survey of 20 United Kingdom and Republic of Ireland paediatric sleep centres (Russo, 2017), all centres reported use of RP for diagnosis of SDB, with 14 centres using this as the main diagnostic method. PSG was performed in 10 centres, contributing a small part of workload (median of total workload: 5% (range: 1%-15%)). The majority of all studies were performed within a hospital setting, with home oximetry/RP use reported in 25% of centres. Indeed, the UK has led the way in home RP (Kingshott 2019). As international leaders in the field acknowledge, ‘the times they are a changing.’ (Gozal 2015)
RP utilises measures of airflow, respiratory effort by inductance plethysmography bands, oxygen saturation, carbon dioxide and heart rate monitoring. This allows accurate detection and discrimination of obstructive, central and mixed apnoeas/hypop...
RP utilises measures of airflow, respiratory effort by inductance plethysmography bands, oxygen saturation, carbon dioxide and heart rate monitoring. This allows accurate detection and discrimination of obstructive, central and mixed apnoeas/hypopnoeas.
Whilst PSG can add useful additional information for complex or subtle SDB presentations, most patients with possible SDB can be adequately assessed using RP, particularly in straightforward OSA.
RP’s set-up and reporting times are shorter than PSG, allowing best use of limited resources, as well as increased ability to perform studies at home.
The utility of RP compared with PSG is very favourable (Tan 2014), although potential for underscoring events (inability to detect EEG arousal on RP) is acknowledged. RP is often better tolerated than PSG in children with complex medical difficulties. In UK centres which have ability to perform PSG, this is usually still not the first choice diagnostic test for SDB assessment.
We agree PSG is the current gold standard for assessment of SDB in children, however RP is the optimal sleep study type for diagnosing most cases of SDB in a high-throughput setting such as the UK.
This approach is recognised in European paediatric consensus guidelines (Kaditis 2016) and follows a paradigm shift away from polysomnography in adult diagnostic services.
Leong KW, Griffiths A, Adams A, et al How to interpret polysomnography
Archives of Disease in Childhood - Education and Practice Published Online First: 15 October 2019. doi: 10.1136/archdischild-2018-316031
Russo, K (2017). Paediatric respiratory sleep studies in UK and Ireland: a survey of current practice. Unpublished Masters thesis, City, University of London, London, UK
(data partially published Archives of Disease in Childhood 2019;104(Suppl 2): A202: G502(P)
Kingshott RN, Gahleitner F, Elphick HE, et al Cardiorespiratory sleep studies at home: experience in research and clinical cohorts
Archives of Disease in Childhood 2019;104:476-481 doi 10.1136/archdischild-2019-rcpch.485
Gozal D, Kheirandish-Gozal L, Kaditis AG Home sleep testing for the diagnosis of pediatric obstructive sleep apnea: the times they are a changing...!
Curr Opin Pulm Med 2015 Nov;21(6):563-
Tan et al Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea
Sleep 2014 Feb 1;37(2):255-60. doi: 10.5665/sleep.3392.
Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2-18
year-old children: diagnosis and management.
Eur Respir J 2016;47(1):69-94.