title: Establishing a Role for Polysomnography in Hospitalized Children.
abstract: BACKGROUND
  Children with medical complexity have a high prevalence of sleep disorders. However, outpatient polysomnography to evaluate for these conditions may be difficult to perform because of lack of skilled nursing care. The aim of this study was to explore polysomnography indications in hospitalized children and assess its impact on patient care.
  
  
  METHODS
  Data from 85 inpatient polysomnographies of 70 children hospitalized between March and December 2014 were retrospectively collected.
  
  
  RESULTS
  Sixty percent of patients were boys with ages 6.5 ± 6 years. Chronic respiratory failure was present in 33.8%, airway obstruction due to defects of the tracheobronchial tree or craniofacial abnormalities in 54.3%, neurological complications of the perinatal period in 22.9%, genetic syndromes and neurodegenerative disorders in 31.4%, congenital myopathies in 5.7%, metabolic diseases in 4.3% and congenital cyanotic heart defects in 4.3%. Indications for polysomnography included assessment of chronic pulmonary disease (60%), ventilator requirements (41.2%), apnea/desaturation (23.5%), and acute life-threatening events (1.2%). Abnormal results were found in 89.4%. The observed diagnosis was obstructive sleep apnea in 64.7%, signs of chronic lung disease in 34.1%, hypoventilation in 9.4%, periodic breathing in 3.5%, and periodic limb movement of sleep in 4.7%. The following interventions were performed: adjustment of ventilator parameters (45.8%), positive airway pressure initiation (24.7%), otorhinolaryngology referral (30.6%), supraglottoplasty (2.4%), tracheostomy decannulation (2.4%), and tracheostomy placement (3.5%). Nine patients had available follow-up polysomnograms, all showing improvement in sleep variables after adherence to recommended interventions.
  
  
  CONCLUSIONS
  In individuals with complex medical disorders, inpatient polysomnographies give invaluable information to guide immediate medical decision making and should be strongly considered if resources allow this.
authors.affiliation: Pediatric Sleep Program, Department of Neurology, New York University Langone Medical Center, New York, New York; Department of Pediatrics, Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Tkachenko
authors.affiliation: Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, Massachusetts.
authors.forename: Kanwaljit
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, New York University, Langone Medical Center, New York, New York.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Abreu
authors.affiliation: Division of Child Neurology, SUNY Downstate, Brooklyn, New York.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Morse
authors.affiliation: Pediatric Sleep Program, Department of Neurology, New York University Langone Medical Center, New York, New York.
authors.forename: Christy
authors.initials: C
authors.lastname: Day
authors.affiliation: Division of Pediatric Pulmonology, Department of Pediatrics, New York University Langone Medical Center, New York, New York.
authors.forename: Kathyrn
authors.initials: K
authors.lastname: Fitzgerald
authors.affiliation: Division of Pediatric Pulmonology, Department of Pediatrics, New York University Langone Medical Center, New York, New York.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kazachkov
authors.affiliation: Pediatric Sleep Program, Department of Neurology, New York University Langone Medical Center, New York, New York. Electronic address: Sanjeev.Kothare@nyumc.org.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kothare
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography / Q000379:methods*; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000209:etiology
keywords: child; child, hospitalized; infant; inpatients; polysomnography; sleep disorders