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Clinical Investigations: SLEEP AND BREATHING |

Is a 2-Night Polysomnographic Study Necessary in Childhood Sleep-Related Disordered Breathing?*

Albert M. Li, MRCP; Yun Kwok Wing, MRCPsych; Agnes Cheung; Dorothy Chan, MRCP; Crover Ho, RPSGT; Stephen Hui, MRCP; Tai Fai Fok, MD, FRCP
Author and Funding Information

*From the Departments of Paediatrics (Drs. Li, Chan, Hui, and Fok) and Psychiatry (Dr. Wing, Ms. Cheung, and Mr. Ho), Prince of Wales and Shatin Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR.

Correspondence to: Yun Kwok Wing, MRCPsych, Department of Psychiatry, Room 7010, Seventh Floor, Shatin Hospital, Shatin, The Chinese University of Hong Kong, Hong Kong; e-mail: ykwing@cuhk.edu.hk



Chest. 2004;126(5):1467-1472. doi:10.1378/chest.126.5.1467
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Background and objectives: There are limited data on the night-to-night variability of childhood sleep-related disordered breathing (SDB). We aim to assess for the presence of first-night effect (FNE) and to examine whether a single-night sleep study is adequate in the assessment of childhood SDB.

Design: In a case-control study investigating whether obesity is a risk factor for childhood SDB, the night-to-night variability of sleep and respiratory variables were studied.

Participants and setting: Forty-six obese children from a pediatric obesity clinic and 44 age- and sex-matched normal weight control subjects from local schools.

Interventions: All subjects underwent two consecutive overnight polysomnographic studies. An obstructive apnea index (OAI) ≥ 1/h was considered diagnostic of SDB.

Results: The mean age of the children was 11.21 years (SD 2.21). Forty-four obese children and 43 control subjects completed the 2-night study. Based on the criterion of the worst OAI over the 2 nights, 13 subjects were found to have SDB, 12 subjects were primary snorers, and 62 were normal subjects. In all subjects, the sleep efficiency improved and sleep-onset latency was reduced on the second night. While there was a rebound of rapid eye movement sleep with the associated worsening of respiratory indexes (mainly accounted for by an increase in central apneas and hypopneas) evident in normal subjects, there was a significant improvement of respiratory disturbances in the SDB group on the second night. The first-night polysomnography would have correctly identified 84.6% of cases as defined by the criteria of the worst OAI over the 2 nights. All cases missed by the first-night study had only borderline OAI.

Conclusions: The phenomenon of FNE in children was well demonstrated in our study. We proposed that a single-night sleep study is adequate and more cost-effective in assessing for childhood SDB.


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