Overview of polysomnography in infants and children
- Madeleine Grigg-Damberger, MD
Madeleine Grigg-Damberger, MD
- Professor of Neurology
- University of New Mexico School of Medicine
Polysomnography (PSG) is a diagnostic sleep medicine tool during which multiple different physiologic parameters are continuously and simultaneously recorded across a sleep period to characterize sleep and identify sleep disorders. Through simultaneous recording of multiple physiologic parameters, particular changes in sleep/wake state or specific abnormalities in one parameter can be correlated with other signals. PSG is thereby a much more powerful diagnostic tool than what can be provided by recording only one or two simultaneous measurements.
Younger and younger children are being referred to sleep specialists and sleep laboratories for evaluation of sleep disorders, which often require PSG for diagnosis, and sometimes treatment. While PSG is considered a painless, noninvasive procedure by most adults, it can be challenging and even frightening for children and therefore requires special considerations.
This topic will provide an overview of PSG in infants and children, including indications for testing, derived information, techniques for obtaining useful data, and scoring and interpretation. An approach to the assessment and classification of specific sleep disorders in children is discussed separately. (See "Assessment of sleep disorders in children".)
TYPES OF SLEEP STUDIES
The American Academy of Sleep Medicine (AASM)  and the Centers for Medicaid and Medicare Services (CMS)  identify four classes of sleep studies based upon how channels are recorded and whether a sleep technologist is present throughout the recording to provide oversight ("attended" or "unattended").
●A level 1 polysomnography (PSG) is performed in a sleep laboratory with a sleep technologist present, recording a minimum of seven channels including electroencephalography (EEG), electrooculography (EOG), submentalis (chin) electromyography (EMG), electrocardiogram (ECG)/heart rate, and pulse oximetry (SpO2).
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- TYPES OF SLEEP STUDIES
- INDICATIONS FOR POLYSOMNOGRAPHY
- CHILD-FRIENDLY TECHNIQUES
- Electrode application
- RECORDED SIGNALS
- Evaluation of sleep/wake state
- Respiratory monitoring
- Detection of movements and behaviors
- Expanded EEG montages
- SCORING AND INTERPRETATION
- SAFETY CONSIDERATIONS
- ALTERNATIVE STUDIES
- INFORMATION FOR PATIENTS