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Sleep, snoring and acute life-threatening events
  1. M Atkinson
  1. Correspondence to Dr Maria Atkinson, Queens Medical Centre, University Hospital Nottingham, Nottingham NG7 2UH, UK; maria{at}

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We have limited time to keep ourselves up-to-date with the latest evidence-based guidelines that are relevant to our individual practice. I expect many paediatricians will have overlooked this new guideline1 on sleep physiology and respiratory control disorders in children as only being relevant to those setting up and running tertiary sleep services. It is clearly of interest to those clinicians but also highly relevant to general and community paediatricians. In the last week, I have referred two colleagues to this guideline who were updating local hospital protocols on acute life-threatening events (ALTEs) and screening for obstructive sleep apnoea (OSA) in children with Down's syndrome.

The guideline has been endorsed by the Royal College of Paediatrics and Child Health (RCPCH). So what does this mean? In brief, this means that the guideline has met the standard laid down by the Clinical Standards Committee at the RCPCH but was not developed by the RCPCH.

Those standards include

  • developing the guideline in conjunction with the Clinical Effectiveness Team at the RCPCH from the outset2;

  • meeting the key criteria of the Appraisal of Guidelines Research and Evaluation instrument (a tool to appraise guidelines,;

  • a review of the evidence supporting the recommendations;

  • ensuring adequate paediatric involvement.

The guideline may be affirmed if only some of the standards are met. Further details can be found on the RCPCH website (

Terminology of sleep studies

Screening (first-line studies)

These studies are used to screen for major abnormalities in high-risk populations or as a preliminary assessment of children with obstructive symptoms using an oximetry recording that includes heart rate and oxygen saturation as a minimum. Ideally, the study should also include carbon dioxide measurement, video, sound and arousal detection.

Second-line studies

These studies are used to assess children where the diagnosis is in doubt or where treatment …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.