Chest
Volume 125, Issue 3, March 2004, Pages 872-878
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Clinical Investigations
SLEEP AND BREATHING
Normal Polysomnographic Respiratory Values in Children and Adolescents

https://doi.org/10.1378/chest.125.3.872Get rights and content

Study objectives

Polysomnography is important in the evaluation of children and adolescents with sleep-disordered breathing. Adult criteria for obstructive sleep apnea have been shown to be inapplicable to children. Nevertheless, very little data are available regarding normal respiratory parameters during sleep in healthy children and adolescents. The purpose of the study was to characterize normal polysomnography values in healthy children and adolescents and to establish respiratory reference values for pediatric polysomnography.

Design, setting and participants

Seventy healthy, normal children and adolescents were studied. Age ranged from 1 to 15 years (mean ± SD, 8.02 ± 4.57 years). All children underwent overnight polysomnography including EEG, electromyography, electrooculography, ECG, pulse oximetry arterial oxygen saturation (Spo2), chest wall and abdomen motion, oral and nasal airflow, and end-tidal Pco2 (Petco2).

Results

Three children (4%) had a mean of 0.37 obstructive apneas (OAs) per hour of sleep (1 to 5 OAs per child per study), with mean apnea duration of 10.3 ± 2.1 s. This was not accompanied with oxygen desaturation. Twenty-six children had one to seven central apneas (CAs) per child, resulting in a mean of 0.4 CAs per hour of sleep (median, 0.33; 97.5 percentile, 0.9). Eleven of the 58 events of CA in six children coincided with oxygen desaturation to a minimum of 88% (nadir apnea desaturation range, 88 to 93%). The mean Spo2 was 97.2 ± 0.8% with Spo2 nadir of 94.6 ± 2.2%. Petco2 > 45 mm Hg occurred for 1.6 ± 3.8% of total sleep time (TST) in 21 of 70 children (30%), with a distribution of 1.3 ± 3.03% in the range of 46 to 47 mm Hg; < 0.7% were within the range of 48 to 50 mm Hg; and in 0.29 ± 0.24% of TST, Petco2 values were > 50 mm Hg.

Conclusions

Based on these data, the recommended limits for normal values are as follows: OA index, 1; CA index, 0.9; oxygen desaturation, 89%; baseline saturation, 92%; and Petco2 > 45 mm Hg for < 10% of TST.

Section snippets

Study Population

Seventy, normal, healthy, white children and adolescents ranging in age from 1 to 15 years were included in the study. They were recruited haphazardly from schools and kindergartens and from families of hospital employees. Only children who were assessed as being normal subjects without SDB by clinical history were included. Children with the following history or findings were excluded from the study: snoring, labored breathing or chest retractions during sleep, sleep apneas, craniofacial

Results

Subjects age ranged from 1 to 15 years (mean ± SD, 7.9 ± 4.4 years). Thirty subjects (43%) were male. The age and sex distributions are shown in Figure 1.

Discussion

Although polysomnography is a common procedure in children, reference values are inadequate. Only one study4 designed to establish normal values in children has been reported. A comparison of the present study to the previous report is presented in Table 2. The present study provides additional information on normal polysomnographic values in children.

Our population included only white children. It has been recently suggested that certain ethnic populations such as African Americans may be at

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