Polysomnographic values in children undergoing puberty: pediatric vs. adult respiratory rules in adolescents

Abstract

Study objectives: Polysomnographic respiratory events in children should be scored using pediatric respiratory rules. However, due to a lack of data on adolescents, recently revised rules allow children aged 13-18 years to be scored by adult or pediatric criteria. To clarify which criteria to use, we describe the evolution of respiratory events with Tanner stage, and we compare events in children aged 13-18 years with the new American Academy of Sleep Medicine adult and pediatric respiratory rules.

Design: Cross-sectional

Setting: Academic hospital

Participants: Healthy subjects aged 8-18 years recruited for research purposes.

Interventions: Physical examination to determine Tanner stage, overnight polysomnogram, and determination of sex hormones.

Results: Sixty-eight subjects (Tanner 1-5) were studied, mean age [SD] = 13 +/- 3 years, median apnea hypopnea index (AHI)= 0.1 (range: 0-1.2)/h. The median percentages of total sleep time (TST) with SpO2 < 92% were 0.1 (0-4.2)%, and with end-tidal CO2 > 50 torr was 0.1 (0-88.6)%. Thirty-two subjects were aged 13-18 years, (Tanner 3-5). The difference between AHI scored by pediatric (median = 0 [0-0.9]/h) and adult (median = 0 [0 - 0.5]/h) criteria was statistically significant (P = 0.043), but not clinically relevant.

Conclusions: Respiratory events in normal children aged 8-18 years are rare and unrelated to Tanner stage. Adult or pediatric respiratory rules can be used for scoring polysomnograms in asymptomatic subjects approaching adulthood. Further studies are needed in symptomatic children within this age group.

Figure 1

Sex distribution according to Tanner stage. Each bar represents the number of subjects within each Tanner stage. The black portion represents the males and the lined portion the females.

Figure 2

Duration of stage N3 (slow wave sleep) according to Tanner Stage. The correlation between stage N3 (slow wave sleep, expressed as percentage of total sleep time [TST]) according to Tanner stage is shown. Pearson's correlation coefficient (r).

Figure 3

Apnea hypopnea index in subset of subjects aged 13–18 years scored by pediatric and adult criteria. Apnea hypopnea index results using pediatric and adult respiratory scoring criteria. The boundaries of the boxes represent the 25th and 75th percentiles. The line within the boxes marks the medians. The whiskers indicate the 10th and 90th percentiles, and the points represent the range. The apnea hypopnea index obtained with adult respiratory rules was significantly lower than with pediatric respiratory rules. However, the observed difference (mean difference = 0.048, SD = 0.14, 95% confidence interval = −0.001 to 0.098) is so small, that it would not be of clinical relevance.