Reflecting this, there was no consensus among providers in our survey regarding the optimum AHIo cutoff for diagnosis of OSA in infants even though standard pediatric criteria exist, suggesting that providers are practicing using different cutoffs. Barriers to development of guidelines are that normative sleep data are limited and the definition of an obstructive respiratory event using PSG (particularly hypopneas) has not been established in infants. Although guidance exists for PSG criteria for OSA and CSA diagnosis in older children, there are no guidelines for infants. 8 In-laboratory overnight PSG is the gold standard for diagnosis of OSA. The etiology of OSA in infants is multifactorial and compared to older children, the diagnosis and treatment is often more complex. Table 1 Summary of key questions and responses highlighting gaps in currently available evidence. Eleven percent stated that the severity of hypoxemia is more important than the absolute AHI in determining management options and only 2% stated that an abnormal AHI without significant hypoxemia (oxygen saturation nadir of ≥ 90%) does not need to be treated. Regarding the most important PSG variable(s) in determining clinical management, 50% of providers stated that abnormal oxygenation or ventilation during a PSG are more important factors in determining management than the absolute AHI value, whereas 37% thought that an abnormal AHI warrants further management regardless of severity of hypoxemia or hypoventilation. When asked regarding indications for PSG in infants, responses were as follows: regardless of symptoms (6%), if there are symptoms of SDB (snoring, noisy breathing, increased work of breathing) awake and asleep (37%), if there are symptoms of SDB (snoring, noisy breathing, increased work of breathing) asleep only (57%), if there are symptoms of SDB (snoring, noisy breathing, increased work of breathing) awake only (0%).
Patterns correlating with country of practice were not observed. Respondents were from 24 different states within the US (45 providers) and 7 other countries. Fifty-four percent of providers stated that PSG was performed more than 30 times per year in infants. Ninety-six percent of providers affirmed that PSG was performed on infants 2 to 12 months of age, whereas 80% performed PSG on neonates.
Eighty percent of providers stated that they performed PSGs on infants younger than 2 months. Infants, including neonates, comprised zero to 5% of the patient population seen by most of the providers (67%). The average number of infants with suspected SDB seen each month by providers were 0 to 5 (54%), 5 to 9 (28%), 10 to 15 (13%), or more than 15 (5%). Providers had been practicing sleep medicine for less than 5 years (26%), 5 to 9 years (26%), 10 to 15 years (22%), or more than 15 years (26%). Most providers were in a primarily academic practice setting (85%), although 13% were in a private group and 2% in a solo practice. Beyond sleep medicine, providers were board certified/eligible in pediatrics (81%), neurology (5%), internal medicine (2%), pulmonology (65%), and family practice (3%). Therefore, the purpose of the current study was to survey sleep medicine providers regarding their current practice patterns for evaluating infants with sleep-disordered breathing (SDB), diagnosing sleep apnea in these infants, and treating their disease.įifty-four pediatric sleep providers completed the survey. Guidelines regarding the diagnosis and management of sleep apnea in children exist, 7 but are not applicable to children younger than 12 months.Ĭurrently, there are no universally accepted criteria used for diagnosing sleep apnea in infants, no consensus guidance on what the management options are, or what the common practice patterns are among sleep providers.
6 Although timely diagnosis and treatment of OSA is imperative to prevent neurocognitive impairment, lack of research has significantly hindered care for these infants. In children, untreated OSA may result in suboptimal neurodevelopmental outcomes and cognitive dysfunction, 1– 3 deleterious cardiovascular sequelae, 4 behavioral and academic challenges, 5 and growth impairment. The prevalence of obstructive sleep apnea (OSA) in infants is unknown because of scarcity of research in this population.