Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 741-753 (doi:10.1542/peds.2005-1067)
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Polysomnographic Characteristics in Normal Preschool and Early School-Aged Children

Hawley E. Montgomery-Downs, PhDa, Louise M. O’Brien, PhDb, Tanya E. Gulliver, MDc and David Gozal, MDb

a Department of Psychology, West Virginia University, Morgantown, West Virginia
b Kosair Children’s Hospital Research Institute and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
c Department of Paediatric Respiratory and Sleep, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia

OBJECTIVE. The objective of this study was to describe overnight polysomnographic measures in normal children aged 3 to 7 years. We conducted a retrospective analysis of normal polysomnographic evaluations from participants in 2 large community-based studies of sleep-disordered breathing among preschoolers and early school-aged children at Kosair Children’s Hospital Sleep Medicine Research Center at the University of Louisville. Participants included 542 healthy children with ages ranging from 3.2 to 8.6 years.

RESULTS. Subjects were excluded from analysis if they had documented snoring during polysomnography, an obstructive apnea-hypopnea index of ≥1.0, or a periodic leg-movement index of ≥5.0. Because the greatest differences in polysomnography occurred between ages 5 and 6 years, analyses were performed for children 3 to 5 years and for ages ≥6. Sleep cyclicity was distinct between age groups, with both showing an initial brief rapid-eye-movement period, which lengthened across the night, but only the older group showing a decrease in cycle length across the night. Average obstructive apnea indices were 0.03 per hour of total sleep time (TST) for 3- to 5-year-old children and 0.05 per hour of TST for ≥6-year-old children, whereas central apnea indices were 0.82 and 0.45 per hour of TST, respectively. Older children spent a greater percentage of sleep time supine, and the apnea-hypopnea index differed according to body position. Twenty percent of all subjects had end tidal carbon dioxide values of >45 mm Hg, and 2.2% had recorded values >50 mm Hg during ≥50% TST. High variance was present on all measures.

CONCLUSIONS. Developmental changes occur in several polysomnographic measures among normal children from 3 to 7 years of age, particularly during transition from preschool to early school age. Our findings in a large number of healthy community children comprise the most extensive compilation of normative reference values for laboratory-based pediatric polysomnography to date.

Key Words: sleep architecture • gas exchange • reference values

Abbreviations: SDB—sleep-disordered breathing • AHI—apnea-hypopnea index • PLM—periodic leg movement • ETCO2—end-tidal carbon dioxide • PETCO2—peak end-tidal carbon dioxide • SpO2—arterial oxygen saturation • TST—total sleep time • TIB—time in bed • REM—rapid eye movement • NREM—nonrapid eye movement sleep • AI—apnea index • SWS—slow-wave sleep • SPS—sleep pressure score • TAI—total arousal index • RAI—respiratory arousal index • SAI—spontaneous arousal index • PR-RSDB—parent report for risk for sleep-disordered breathing

Accepted Nov 17, 2005.




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