What are the reference-range parameters for sleep study findings in children with obstructive sleep apnea (OSA)?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Answer

Compared with the adult literature, the available normative data for sleep and cardiorespiratory parameters are rather sparse in the pediatric literature, such that most pediatric sleep laboratories use individually established reference ranges rather than referring to an authoritative text. Nevertheless, the general consensus criteria for a normal finding on sleep study are presented below and have been derived from the published literature on this subject and the authors' experience.

Reference-range parameters for sleep gas exchange and gas exchange in children are as follows (see also the image below):

  • Sleep latency - More than 10 minutes

  • Total sleep time (TST) - More than 5.5 hours

  • Percentage of rapid eye movement (REM) sleep - More than 15% of TST

  • Percentage of stage 3-4 non-REM sleep - More than 25% of TST

  • Respiratory arousal index (number per hour of TST) - Less than 5

  • Periodic leg movements (number per hour of TST) - Less than 1

  • Apnea index (number per hour of TST) - Less than 1

  • Hypopnea index (nasal/esophageal pressure catheter; number per hour of TST) - Less than 3

  • Nadir oxygen saturation - More than 92%

  • Mean oxygen saturation - More than 95%

  • Desaturation index (>4% for 5 s; number per hour of TST) - Less than 5

  • Highest carbon dioxide level - 52 mm Hg

  • Carbon dioxide level of more than 45 mm Hg - Less than 20% of TST

    Normal parameters for sleep gas exchange and gas e Normal parameters for sleep gas exchange and gas exchange in children.

The adult criteria usually used around the world for the diagnosis of obstructive sleep apnea do not apply to children. In fact, the finding of 10-15 obstructive apneic events per hour of sleep, which represents mild obstructive sleep apnea in an adult patient in whom treatment may not even be contemplated, represents a sleep-related respiratory disturbance corresponding to a severely affected child definitely in need of therapeutic intervention. Thus, an apnea hypopnea index (AHI) of more than 5 events per hour clearly represents an indication for treatment in children. An AHI of fewer than 3 events per hour does not require any intervention, and, in children with an AHI of more than 3 but fewer than 5 events per hour, the benefit of treatment remains to be determined.


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