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Commentary |

Pediatric Home Sleep Apnea TestingHome Sleep Testing in Children: Slowly Getting There!

Hui-Leng Tan, MBBS; Leila Kheirandish-Gozal, MD; David Gozal, MD, MBA, FCCP
Author and Funding Information

From the Department of Paediatric Respiratory Medicine (Dr Tan), Royal Brompton Hospital, London, England; and the Sections of Pediatric Sleep Medicine and Pediatric Pulmonology (Drs Kheirandish-Gozal and Gozal), Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.

CORRESPONDENCE TO: David Gozal, MD, MBA, FCCP, Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 E 57th St, Mailbox 4, Chicago, IL 60637; e-mail: dgozal@uchicago.edu


FUNDING/SUPPORT: This work is supported by the National Institutes of Health [Grant HL-65270 to L. K.-G. and D. G.].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):1382-1395. doi:10.1378/chest.15-1365
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Published online

Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel.


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