Evie Summers
Sleep is an important part of a child's life, and inadequate sleep can affect their well-being, school performance, and behaviour. A sleep study can be used to help determine if there is a medical reason for a child's sleep problems. Sleep problems are common in childhood, with up to 40% of parents reporting concerns about their child's sleep to their paediatrician. Sleep disorders can cause a host of problems, ranging from fatigue and sleepiness during the day to hyperactivity, trouble in school, and frequent infections. A sleep study can help diagnose these problems and inform treatment options.
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What You'll Learn
To check for sleep apnea
Sleep apnea is a condition that causes people to periodically stop breathing while they sleep. This happens either because of a blockage of the airway (obstructive sleep apnea) or because the brain doesn't control breathing as expected (central sleep apnea).
Obstructive sleep apnea (OSA) occurs when the muscles in the throat relax while asleep, causing the surrounding tissue to press on the windpipe and block air movement. Central sleep apnea (CSA) happens when the brain fails to send signals to keep the breathing-related muscles working while the patient sleeps. There is also a third type of sleep apnea, mixed/complex sleep apnea, which is a combination of OSA and CSA.
Sleep apnea can cause serious complications, including excessive daytime sleepiness or "microsleeps" where the patient falls asleep for very brief periods during the day. This can be dangerous if the patient is driving or operating machinery. Sleep apnea can also cause heart arrhythmias, heart damage, and even sudden cardiac death.
A sleep study can help diagnose sleep apnea in children. The study is an overnight test that can record a variety of body functions while the child sleeps, including heart rate, breathing, blood oxygen levels, brain waves, and more. Sensors are placed on the child's head, chin, legs, and around the eyes, and an elastic belt is put around the child's chest and stomach to measure breathing. The sensors connect to a computer to provide information during sleep.
If sleep apnea is diagnosed, treatment options may include using a continuous positive airway pressure (CPAP) machine, managing any underlying conditions that cause or increase the risk of sleep apnea, changing the child's sleeping position, wearing an oral appliance to keep the airway open, or surgery to remove enlarged tonsils and/or adenoids.
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To monitor sleep disorders
Sleep studies are an important way to monitor sleep disorders in children. Sleep disorders can have a significant impact on a child's health and well-being, and can also affect the child's family. Poor sleep can lead to a range of problems, from fatigue and sleepiness during the day to hyperactivity, trouble in school, and even frequent infections.
One of the most common sleep disorders in children is sleep apnea, which affects up to 5% of kids today. Sleep apnea involves temporary cessations in breathing or reduced breathing for 10 or more seconds at a time during sleep, preventing the deeper, restorative sleep that children especially need. In children, sleep apnea is often caused by enlarged tonsils or adenoids, but it can also be linked to obesity, with added weight in the chest and neck impinging on the airway. Other causes include upper airway anatomical abnormalities.
Symptoms of sleep apnea include frequent snoring, abrupt arousals and difficulty staying asleep, waking with a sore throat or dry mouth, morning headaches, difficulty waking in the morning, daytime sleepiness, moodiness or other behavioural problems, depression or attention problems, and bedwetting in children who are potty-trained. If a child exhibits any of these symptoms, the American Academy of Pediatrics recommends that they be evaluated for a sleep study.
Sleep studies, or polysomnograms, are overnight tests that can record a variety of body functions while a child sleeps. Sensors are placed on the child's head, face, arms, legs, and stomach to study brain and muscle activity, and measure heart rate and rhythm. Small plastic prongs are also placed in the child's nose to measure airflow. The tests can help diagnose conditions such as sleep apnea, restless leg syndrome, insomnia, and narcolepsy, and can inform treatment decisions.
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To evaluate serious medical conditions
Sleep studies can be used to evaluate serious medical conditions in children. Sleep-disordered breathing (SDB) is an umbrella term that covers snoring and more serious conditions such as sleep apnea. Obstructive sleep apnea (OSA) is a common condition in which a child's breathing stops and starts during sleep, preventing them from getting the deep, restorative sleep that is crucial for their development. This can be caused by enlarged tonsils or adenoids, or by upper airway anatomical abnormalities. Being overweight is also a significant cause and risk factor for OSA.
A sleep study can be used to confirm or rule out OSA, particularly in children with daytime attention and learning issues. It is also recommended for children who are obese, as they are at a much higher risk of developing OSA. A sleep study is also useful when there is doubt that an adenotonsillectomy is needed, to avoid unnecessary surgery. If a child is at high risk of complications during or after surgery, a sleep study can also inform post-operative care decisions.
The latest AAO-HNS guidelines, endorsed by the American Academy of Sleep Medicine and the American Academy of Pediatrics, recommend a sleep study if the patient is under two years old or if they exhibit obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses.
Sleep apnea can cause a range of issues for children, including frequent infections, difficulty concentrating, hyperactivity, and fatigue. It can also lead to poor school performance, behavioural issues, and possibly cardiovascular consequences if left untreated.
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To assess snoring
Loud snoring is not common in children, and it can be a cause for concern, especially when it interferes with a good night's sleep. Pediatric sleep-disordered breathing (SDB) is a general term for breathing difficulties during sleep, and snoring is the noise caused by the vibration of the uvula and soft palate in the back of the throat. The loudness of snoring is determined by the amount of air passing through, the vibration and collapse or relaxation of the throat tissue during sleep.
If your child is snoring, it is important to be aware of other symptoms that may indicate a sleep disorder. These can include:
- Repeated episodes of under-breathing (hypopnea) and/or complete pauses in breathing (apnea) during sleep.
- Gasping or snorting, restless sleep, frequent night-time awakenings, teeth grinding, bed-wetting, and unusual sleep positions.
- Tiredness during the day, difficulty waking up in the morning, and the need for naps during the day.
- Hyperactivity or poor behaviour.
- Poor concentration and mild educational difficulties.
If you notice any of these symptoms in addition to snoring, it is recommended to consult a pediatrician or a pediatric sleep specialist to determine if a sleep study is necessary. A sleep study can help evaluate the degree of obstruction and determine if there is a medical reason for your child's snoring.
A sleep study typically involves monitoring your child's sleep patterns, breathing, oxygen and carbon dioxide levels, leg and body movements, and in some cases, brain activity. The data collected from the sleep study will help specialists diagnose any sleep disorders and recommend appropriate treatment options.
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To diagnose narcolepsy
Narcolepsy is a sleep disorder that causes an urge to fall asleep suddenly during the day. This urge is almost impossible to resist and can be highly disruptive to a child's life, affecting their ability to learn at school and maintain social relationships and participation in activities.
A sleep study can help diagnose narcolepsy as people with this condition enter the REM stage of sleep unusually quickly after falling asleep. A sleep study will also be able to detect the periods of wakefulness that interrupt their sleep.
If narcolepsy is suspected, a doctor will likely recommend a sleep study, which usually includes an overnight stay in a sleep laboratory, followed by a series of five daytime naps. The overnight stay is called a polysomnogram and involves a recording of brain waves, eye movements, muscle tone, and breathing across a night of sleep. The daytime naps are called a Multiple Sleep Latency Test (MSLT) and are used to determine whether the prior night's sleep is affecting the ability to nap during the day.
The polysomnogram helps assess brain activity during sleep, in particular, how frequently and when REM activity is occurring. The MSLT is often the most important test for diagnosing narcolepsy. If someone has narcolepsy, the MSLT usually reveals that the person falls asleep rapidly (in less than eight minutes on average across the naps) and enters REM sleep during two or more naps.
In some cases, a spinal tap (lumbar puncture) may be recommended to check for low levels of orexin in the cerebrospinal fluid, which is a key indicator of narcolepsy.
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Frequently asked questions
A sleep study can help determine if there is a medical reason for a child's poor sleep. Sleep problems can cause a host of issues, including fatigue, hyperactivity, trouble in school, and behavioural issues.
Signs that a child might need a sleep study include frequent snoring, abrupt arousals at night, difficulty waking in the morning, daytime sleepiness, and behavioural issues such as depression or attention problems.
During a sleep study, sensors are placed on the child's head, chin, legs, and around the eyes, and an elastic belt is put around their chest and stomach to measure breathing. The sensors connect to a computer to monitor various body functions, such as blood oxygen levels, snoring, body movements, and sleep positions.
To prepare for a sleep study, your child should get a normal night's sleep the night before and avoid caffeine. They should also bring personal items, such as a favourite pillow or blanket, to help them feel comfortable during the study.
