Practice Parameters for the Respiratory Indications for Polysomnography in Children
Practice Parameters for the Respiratory Indications for Polysomnography in Children
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DOI：
10.1093/sleep/34.3.379
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发表时间：
2011-03-01
期刊：
影响因子：
5.6
通讯作者：
Ramar, Kannan
中科院分区：
文献类型：
--
作者：
Aurora, R. Nisha;Zak, Rochelle S.;Ramar, Kannan
背景：儿科睡眠医学的文献和实践显着扩大；然而，最近没有报道基于证据的实践参数。这些实践参数是评估儿童多导睡眠图适应症的两篇论文中的第一篇。本文讨论了疑似睡眠相关呼吸障碍儿童的多导睡眠监测适应症。这些建议经过美国睡眠医学会董事会的审查和批准。方法：对文献进行系统回顾，并使用美国神经病学学会分级系统评估证据质量。PSG 使用建议： 1．儿童多导睡眠图应根据 AASM 睡眠和相关事件评分手册的建议进行和解释。 （标准）2．当临床评估提示诊断儿童阻塞性睡眠呼吸暂停综合征 (OSAS) 时，需要进行多导睡眠监测。 （标准）3．术前患有轻度 OSAS 的儿童应在腺样体扁桃体切除术后进行临床评估，以评估残留症状。如果存在 OSAS 残留症状，应进行多导睡眠图检查。 （标准）4．对于术前有中度至重度 OSAS、肥胖、阻塞上气道的颅面异常和神经系统疾病（例如唐氏综合征、普瑞德威利综合征和脊髓脊膜膨出）证据的儿童，在腺样体扁桃体切除术后需要进行多导睡眠监测，以评估残余 OSAS。 （标准）5．多导睡眠图适用于患有阻塞性睡眠呼吸暂停综合征的儿童进行气道正压 (PAP) 滴定。 （标准）6．当临床评估提示诊断为先天性中央肺泡通气不足综合征或由于神经肌肉疾病或胸壁畸形导致的睡眠相关通气不足时，需要进行多导睡眠图检查。它适用于某些婴儿原发性睡眠呼吸暂停病例。 （指南）7．当有临床证据表明经历过明显危及生命事件 (ALTE) 的婴儿存在睡眠相关呼吸障碍时，需要进行多导睡眠监测。 （指南）8。多导睡眠图适用于考虑进行腺样体扁桃体切除术以治疗阻塞性睡眠呼吸暂停综合征的儿童。 （指南）9．对接受长期 PAP 支持的儿童进行后续 PSG 旨在确定压力需求是否因儿童的生长和发育而发生变化，在接受 PAP 期间是否症状复发，或者是否采取了额外或替代治疗。 （指导方针）10．患有上颌快速扩张的 OSAS 儿童治疗后需要进行多导睡眠监测，以评估残留疾病的水平并确定是否需要额外治疗。 （选项）11。使用口腔矫治器治疗 OSAS 的儿童应进行临床随访和多导睡眠监测，以评估治疗反应。 （选项）12。多导睡眠图适用于患有其他睡眠相关呼吸障碍的儿童的无创正压通气 (NIPPV) 滴定。 （选项）13。接受机械通气治疗的儿童可能会受益于多导睡眠图的定期评估以调整呼吸机设置。 （选项）14。作为拔管前评估的一部分，接受气管造口术治疗睡眠相关呼吸障碍的儿童受益于多导睡眠图。这些儿童在拔管后应进行临床随访，以评估睡眠相关呼吸障碍症状的复发情况。 （选项）15。仅当临床怀疑伴有睡眠相关呼吸障碍时，才需要进行多导睡眠图检查：慢性哮喘、囊性纤维化、肺动脉高压、支气管肺发育不良或胸壁异常（例如脊柱后侧凸）。 （选项）反对 PSG 使用的建议：16。不建议使用 Nap（缩写）多导睡眠图来评估儿童阻塞性睡眠呼吸暂停综合征。 （选项） 17. 考虑接受补充供氧治疗的儿童通常不需要多导睡眠图来管理氧疗。 （选项）结论：目前儿科睡眠医学领域的证据表明，PSG 在诊断和治疗睡眠相关呼吸障碍方面具有临床实用性。儿科人群 SRBD 的准确诊断最好通过将多导睡眠图检查结果与临床评估相结合来完成。
Background: There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine.Methods: A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence.Recommendations for PSG Use:1. Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard)2. Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard)3. Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard)4. Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e. g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard)5. Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard)6. Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline)7. Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline)8. Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome. (Guideline)9. Follow-up PSG in children on chronic PAP support is indicated to determine whether pressure requirements have changed as a result of the child's growth and development, if symptoms recur while on PAP, or if additional or alternate treatment is instituted. (Guideline)10. Polysomnography is indicated after treatment of children for OSAS with rapid maxillary expansion to assess for the level of residual disease and to determine whether additional treatment is necessary. (Option)11. Children with OSAS treated with an oral appliance should have clinical follow-up and polysomnography to assess response to treatment. (Option)12. Polysomnography is indicated for noninvasive positive pressure ventilation (NIPPV) titration in children with other sleep related breathing disorders. (Option)13. Children treated with mechanical ventilation may benefit from periodic evaluation with polysomnography to adjust ventilator settings. (Option)14. Children treated with tracheostomy for sleep related breathing disorders benefit from polysomnography as part of the evaluation prior to decannulation. These children should be followed clinically after decannulation to assess for recurrence of symptoms of sleep related breathing disorders. (Option)15. Polysomnography is indicated in the following respiratory disorders only if there is a clinical suspicion for an accompanying sleep related breathing disorder: chronic asthma, cystic fibrosis, pulmonary hypertension, bronchopulmonary dysplasia, or chest wall abnormality such as kyphoscoliosis. (Option)Recommendations against PSG Use:16. Nap (abbreviated) polysomnography is not recommended for the evaluation of obstructive sleep apnea syndrome in children. (Option) 17. Children considered for treatment with supplemental oxygen do not routinely require polysomnography for management of oxygen therapy. (Option)Conclusions: Current evidence in the field of pediatric sleep medicine indicates that PSG has clinical utility in the diagnosis and management of sleep related breathing disorders. The accurate diagnosis of SRBD in the pediatric population is best accomplished by integration of polysomnographic findings with clinical evaluation.