INDICATIONS AND RECOMMENDED DIAGNOSTIC STUDIES IN CHILDREN

1. INDICATIONSAND RECOMMENDED DIAGNOSTIC STUDIESIN CHILDREN

2. UNDERLYING CHRONIC LUNG DISEASE: BPD, CF, ASTHMA NEUROMUSCULAR DISEASE ALVEOLAR HYPOVENTILATION SYNDROME OBSTRUCTIVE SLEEP APNEA INFANTILE APNEA/ ALTE INDICATIONS FOR POLYSOMNOGRAPHYIN CHILDREN

3. SUSPECTED NOCTURNAL SEIZURES (VIDEO EEG) SUSPECTED NARCOLEPSY (MSLT NEXT DAY) VENTILATOR FOLLOWUP (YEARLY) CPAP ADJUSTMENT (q 2 YEARS & PRN) ADDITIONAL INDICATIONS FOR PSG IN CHILDREN

4. HIGH RISK GROUP FOR OSA EXTENDED O2 MONITORING IN ALL PATIENTS, AWAKE, ASLEEP & FEEDING NOCTURNAL O2 MONITORING IF O2 <92% WHEN AWAKE NAP OR NOCTURNAL PSG IF APNEA, BRADYCARDIA OR OSA IS SUSPECTED BRONCHOPULMONARYDYSPLASIA (BPD)

5. NOCTURNAL O2 MONITORING IF AWAKE PaO2 < 72mmHG PSG IF SNORING, DESATURATION ON NIGHTTIME O2 PSG IF PROGRESSION OF COR PULMONALE, POLYCYTHEMIA OR DISTURBED SLEEP ON O2 CYSTIC FIBROSIS

6. ASTHMA NOT ROUTINELY RECOMMENDED

7. PSG IF DIAPHRAGM IMPAIRMENT PRESENT PSG WHEN VC < 800CC PSG IF AWAKE PaCO2 > 45 TORR PSG PREOP SCOLIOSUS SURGERY PSG MUST INCLUDE MEASURE OF ETCO2 AND PRESENCE OF REM SLEEP NEUROMUSCULAR DISEASE

8. A DISORDER OF PERIPHERAL OR CENTRAL CHEMORECEPTOR FUNCTION, EITHER CONGENITAL OR ACQUIRED, MANIFESTED BY DISORDERED BREATHING DURING SLEEP ALVEOLAR HYPOVENTILATIONSYNDROME

9. PSG FOR INITIAL EVALUATION IN ALL PATIENTS PSG POST PHARMACOLOGIC INTERVENTIONS PSG IF CHANGE IN PHYSICAL STATUS ALVEOLAR HYPOVENTILATIONSYNDROME

10. A DISORDER OF BREATHING DURING SLEEP CHARACTERIZED BY HYPOVENTILATION AS A RESULT OF PROLONGED PARTIAL UPPER AIRWAY OBSTRUCTION PUNCTUATED WITH INTERMITTENT COMPLETE OBSTRUCTION OBSTRUCTIVE SLEEP APNEA

11. NapPSG Indications: 1) BRADYCARDIA IS PRESENT 2) OBSTRUCTIVE APNEA IS SUSPECTED (if patient was premature, required CPAP, family history of OSA) 3) SYMPTOMATIC APNEA 4) DESATURATION SPECIALIZED STUDIES MAY BE REQUIRED TO EVALUATE FEEDING, FOR GER OR TO ASSESS IN CARSEAT INFANTILE APNEA

12. 1. FRANK OBSTRUCTIVE EPISODES MAY BE BRIEF OR ABSENT 2. PARTIAL OBSTRUCTION WITH PaCO2>45 TORR MOST COMMON FINDING 3. SLEEP DISRUPTION VERY COMMON 4. "MINIMAL" SLEEP ABNORMALITIES HAVE GREATER SIGNIFICANCE OBSTRUCTIVE SLEEP APNEA ADULT VS CHILD

13. SNORING VOLUME AND AMOUNT OF LYMPHOID TISSUE PRESENT DOES NOT DISTINGUISH PRIMARY FROM PATHOLOGIC SNORING RISKS AND COST OF SURGERY AND ANESTHESIA ARE SIGNIFICANT SEVERELY AFFECTED PATIENTS MAY REQUIRE CLOSER POST-OP OBSERVATION T & A MAY NOT BE CURATIVE PSG VS T&A

14. DIRECTOR: PEDIATRICIAN TRAINED IN LUNG DISEASE & SLEEP MEDICINE PERSONNEL: EXPERIENCE W CHILDREN OF ALL AGES & CERTIFIED IN PCPR SETTING: AGE APPROPRIATE & NON-THREATENING, ACCOMODATIONS FOR PARENT TIMING: OVERNIGHT, NATURAL CARDIOPULMONARY POLYSOMNOGRAPHY PERSONNEL, TECHNOLOGY, METHODS

15. CARDIOPULMONARYPOLYSOMNOGRAPHY REPEAT PSG RECOMMENDED: CHILDREN UNDER 2 YEARS OF AGE. CHILDREN W SNORING 6-8 WKS S/P T& A CHILDREN W CRANIOFACIAL ABNOMALITIES OBESE CHILDREN S/P T&A OR WEIGHT REDUCTION

16. SLEEP STAGING EKG NASAL & ORAL AIRFLOW, ETCO2 O2 SATURATION W OXIMETRY PULSE SIGNAL AUDIOVIDEO RECOMMENDED CARDIOPULMONARYPOLYSOMNOGRAPHY MINIMUM MEASUREMENTS REQUIRED

17. CENTRAL APNEA: ALL > 20 SEC; CA > 20 SEC IF ASSC W BRADY OR DESAT > 4% PERIODIC BREATHING: DURATION AS %TST, SLEEP STAGE & EFFECT ON HR & O2 OBSTRUCTIVE APNEA: OA > 2 MISSED BREATHS, ASSC DESAT, SLEEP STAGE, OA/TST CARDIOPULMONARYPOLYSOMNOGRAPHY SCORING

18. HYPOVENTILATION: OBSTRUCTIVE -- ETCO2 >45 TORR ASSC W PARADOXICAL BREATHING NON-OBSTRUCTIVE -- ETCO2 >45 TORR ASSC W IN-PHASE RESP MOVEMENTS CARDIOPULMONARYPOLYSOMNOGRAPHY SCORING, CONT

19. CARDIOPULMONARYPOLYSOMNOGRAPHY SCORING, CONT OXYGENATION: SaO2 < 92% OR D>4% CARDIAC: RATE, RHYTHM & ASSOCIATIONS BEHAVIOR: POSITION, AROUSALS & MOVEMENTS