Pediatric Polysomnography Flashcards

According to AASM guidelines, what is the minimum duration for scoring an obstructive apnea in an infant?

Answer: The duration of 2 breaths

The AASM manual specifies that for infants and children, an obstructive apnea is scored when there is a cessation of airflow for a duration of at least two missed breaths. This is accompanied by continued or increased inspiratory effort. This rule accounts for the much faster and more variable respiratory rate in infants compared to adults.

Which of the following sleep stages is scored in infants but NOT in adults?

Answer: Indeterminate Sleep

Indeterminate Sleep is a unique stage scored in infants when an epoch cannot be clearly defined as Quiet Sleep (N), Active Sleep (R), or Wake. This stage acknowledges the frequent transitional and mixed-state periods that are characteristic of infant sleep architecture development.

A central apnea in a child (older than 1 year) is scored if there is a cessation of airflow and effort lasting at least:

Answer: 20 seconds, OR a shorter duration if associated with an arousal or ≥3% desaturation

For children over 1 year, a central apnea requires a duration of at least 20 seconds. Alternatively, it can be scored if it has a shorter duration (but must last for at least 2 breaths) and is associated with either an arousal or a 3% or greater oxygen desaturation.

Which procedural adaptation is most critical for ensuring a successful PSG on a 5-year-old child?

Answer: Allowing a parent or caregiver to stay overnight in the room.

Allowing a parent or caregiver to co-sleep or stay in the room is a standard and highly recommended practice in pediatric polysomnography. The parent's presence provides comfort and security, which reduces child anxiety, improves cooperation during the hookup process, and leads to a more representative night of sleep.

What is the minimum duration for scoring an arousal from NREM sleep in a school-aged child?

Answer: 3 seconds

The scoring rule for arousals is consistent for adults and children. An arousal is defined as an abrupt shift in EEG frequency (to alpha, theta, and/or frequencies greater than 16 Hz) that lasts for at least 3 seconds, with at least 10 seconds of stable sleep preceding the change.

When scoring a pediatric study, you observe frequent, brief central apneas (5-10 seconds long) followed by a few large breaths, primarily during sleep onset. The infant is otherwise healthy. This pattern is most likely:

Answer: Periodic breathing, a normal finding in many infants.

Periodic breathing is a common and usually benign pattern in infants, characterized by cycles of brief central apneas followed by periods of normal breathing. It is defined as three or more central apneas lasting >3 seconds separated by no more than 20 seconds of normal breathing. It is most common in premature infants but can be seen in healthy term infants as well.