Journal Article

British Thoracic Society guideline for diagnosing and monitoring paediatric sleep-disordered breathing

Ismail-Koch, Hasnaa, Morley, Andrew, Chan, Samantha YS, Tan, Hui Leng, Yanney, Michael, Russo, Kylie, Harman, Katharine, Gavlak, Johanna, Langley, Ross, Whitney, Andrea, Gibson, Neil A, Tweedie, Daniel, Samuels, Martin P, Bennett, Joanna, Opstad, Kirstie S, Kingshott, Ruth N, Evans, Hazel J

2023

Overview

Diagnosing sleep-disordered breathing in children with suspected sleep-disordered breathing Sleep questionnaires, combined sleep questionnaires and ‘protocol-driven’ clinical assessments, sleep video recordings and sleep audio recordings Children without comorbidities Recommendations The Sleep-Related Breathing Disorder scale of the Paediatric Sleep Questionnaire (SRBD-PSQ), with a cut-off of ≥0.33, or Obstructive Sleep Apnoea-18 item questionnaire (OSA-18), with a cut-off of ≥0.60, can be considered for diagnosing moderate-to-severe SDB in children of at least 2 years of age with no comorbidities. While pulse oximetry is non-discriminatory at all ages, particular caution is required in using oximetry to diagnose OSA in children under 2 years of age as children in this age group are predisposed to central sleep apnoea (CSA) (as a result of developmental immaturity) and oxygen desaturations cannot discriminate between obstructive and central events. If hypoventilation is suspected, please refer to the ‘Pulse oximetry and carbon dioxide (CO2) monitoring’ recommendations and GPPs below. The American Academy of Sleep Medicine (AASM) recommends scoring hypoventilation during sleep when >25% of the total sleep time, as measured by either the arterial PCO2 or surrogate (transcutaneous or end tidal which is more relevant in paediatrics), is spent with a PCO2 >50 mm Hg/6.7 kPa.3 Home monitoring (pulse oximetry or CRSS) Recommendation Home CRSS can be considered for diagnosing SDB in children without comorbidities where the patients and/or carers are deemed appropriate for implementing a home sleep study.

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
• Subject: Airway management / BTS Guideline / Carbon dioxide / Caregivers / Child / Decision making / Diagnostic tests / Down syndrome / Humans / Hypoventilation / Patients / Pediatrics / Pulse oximetry / Questionnaires / Sleep apnea / Sleep Apnea Syndromes - diagnosis / Sleep Apnea, Obstructive - diagnosis / Sleep Apnea, Obstructive - therapy / sleep apnoea / Sleep disorders