What is a sleep study?
Sleep studies measure your child's breathing, heart rate and rhythm, oxygen and carbon dioxide levels and movements, in addition to how much and how well they sleep.
We typically are not conscious of what is happening while we are asleep. For instance, we could snore, have laboured breathing, or make odd motions. If the doctor suspects your child has a sleep condition, such as sleep apnea or hypoventilation, they may advise that they undergo a sleep study.

Why does my child need a sleep study?
If your kid has a sleep-related breathing disorder, it's critical to objectively confirm the diagnosis and identify the type and severity, which will guide treatment. Disorders of sleep can affect the heart, the brain, or mood and conduct. For instance, having a restless night might cause your child to be exhausted the next day and find it challenging to focus in class.
There are conditions (e.g. ears, nose, throat (ENT), neuromuscular, craniofacial, metabolic and others) which may make your child more susceptible to sleep related breathing disorders and a sleep study is helpful in guiding management in these cases.
A sleep study is also utilised if your child is receiving ventilation to determine whether it is effective and to make any adjustments if required.

What are the signs and symptoms of sleep apnea in children?

  • Snoring or noisy breathing
  • Gasping or choking during sleep
  • Mouth breathing
  • Abnormal breathing pattern
  • Neuromuscular weakness
  • Observed absence of breathing during sleep
  • Restlessness during sleep
  • Daytime sleepiness or fatigue
  • Daytime irritability or hyperactivity (ADHD)
  • Poor school performance
  • Bed wetting
  • Teeth grinding
  • Early morning headache
  • Weight gain (High BMI)
  • Difficulty waking up in the morning
  • Growth and developmental challenges

These are the risk factors of sleep related breathing disorders in children:

  • Adenotonsillar hypertrophy
  • Obesity
  • Family history of OSA (Obstuctive sleep apnea)
  • Orthodontic problems (e.g. high narrow hard palate, overlapping incisors, crossbite)
  • Craniofacial anomalies (e.g. retrognathia, micrognathia, midface hypoplasia)
  • History of low birth weight
  • History of prematurity and multiple gestation
  • Achondroplasia
  • Several chronic/complex/genetic condition that requires routine sleep study:
    • Neuromuscular diseases (spinal muscular atrophy, Duchenne muscular dystrophy)
    • Trisomy21 (Down syndrome)
    • Congenital central hypoventilation syndrome (CCHS)
    • Mucopolysaccharidoses (eg, Hunter syndrome and Hurler syndrome)
    • Sickle cell disease
    • Cerebral palsy
    • Prader-Willi syndrome
    • Cystic Fibrosis

Additional reasons for a sleep study are:

  • Parasomnias (sleep walking, night terrors, sleep talking, etc.)
  • Monitoring of CPAP (continuous positive airway pressure) or BIPAP (Bi-level positive airway pressure)
  • Determination of respiratory needs for oxygen and ventilator support
  • Restless leg syndrome and periodic limb movement disorder

Objective assessment with PSG is recommended in children with complex medical conditions who present with signs and symptoms of OSA.

What do we need to bring for the sleep study?

One parent/guardian is encouraged to spend the night with the child. A parent/guardian is responsible for the child all the time. No other children are permitted in the sleep laboratory during the sleep study. Don't forget to bring the following items:

  • Your child’s ventilator (for example, CPAP or BiPAP) if this is used while at home. Bring all equipment (ventilator, masks, tubing etc).
  • Anything else that your child usually sleeps with, such as a soft toy, or favourite book for bedtime stories. Linens, pillows, and blankets will be provided but please feel free to bring your child’s own special pillows, duvets or blankets to make your child feel more comfortable.
  • Your child’s comfortable sleepwear like pyjamas. No one-piece footed pyjamas please.
  • Any medication, formula, special foods, and medical equipment your child usually needs. Please bring baby wipes and diapers, if necessary.
  • For patients less than 18 months of age, please bring an extra pair of socks to keep busy hands from needlessly pulling sensors off.

What do we need to do during the day of the study?
The day of the sleep study should be a normal day for you child. He/she can take her maintenance medications (unless directed otherwise by the referring physician), no food and drink restrictions. Your child should limit caffeinated products (coffee, tea, chocolate, soda, etc.) at least 24 hours before the study.
Wake your child earlier than her normal routine and keep him/her awake and active throughout the day. Limit nap time to a minimum to maximise sleep during the study.
Bathe the child before coming to the sleep laboratory. Make sure that your child has clean, dry hair. No product of any kind (e.g. oil, wax, or gel) in the hair or on the scalp. The child should have light dinner before coming for the sleep study.

What will happen once we arrive?

The sleep technologist will take you to your child's bedroom to get settled then talk to you about the sleep study in more detail. This is a chance for you to ask any questions you may have. Please inform the sleep technologist if your child has any allergies (e.g. to latex or tapes) or has other devices fitted (e.g. a pacemaker).
While awake and ready for bed, your child will be prepared for the study; this involves attachments of the following:

  • Two sticky ECG electrodes are placed on your child’s chest to measure heart rhythm
  • Two sticky electrodes are placed on each leg to monitor your child’s leg movements
  • A soft sensor placed around the toe or finger to record their oxygen levels and heart rate while asleep
  • Two stretchy bands/belts are placed around the chest, usually over the night clothes, to record breathing movements and efforts
  • A small sensor is placed on the chest to record sleeping position
  • A sensor will be placed on the child’s neck to monitor snore vibrations
  • A small plastic prongs is taped at the edge of the nostrils to monitor the breathing.
    a small sensor is taped on the collarbone, cheeks, or forehead to record transcutaneous carbon dioxide
  • Small gold disk electrodes taped in various locations on the child’s face to measure eye movements and muscle tone during sleep.
  • Additional gold disk electrodes will be placed on your child’s scalp with a washable paste, to monitor stages of sleep
    a video and audio recording of your child’s sleep will also be made

TV is available in the room for your child to watch during the hook-up process. Cell phones and tablets can also be used to distract the child. Once all sensors have been attached, your child will be allowed to sleep. All electronic use should be discontinued. Your child will sleep on a bed with full length side rails.

How long will the study take?
Sleep study requires a one night stay at Mediclinic City Hospital. You will be informed in advance if it is likely to be any longer (for example, minimum six hours total sleep time is not met, or if the optimal pressure is not yet obtained if the patient is on CPAP or BIPAP titration).
Sleep studies are painless. No needles involved. There are no risks or long term effects, so you will be able to return to your normal routine once you leave.
Dinner can be arranged for the parent/guardian. We prefer the child to eat a light dinner before coming to the test to avoid delays. In the morning, breakfast can also be arranged and will be provided at 8am.

When can we go home?
The sleep technologist will remove the sensors once enough data is obtained and your child wakes up in the morning. The sensors will be removed at 6am to 6.30am and you may leave once the discharge process is done. The sleep laboratory closes at 8.30am so please ensure you are ready to leave the unit before this time.

How long does it take to get the result of the sleep study?
The doctor will review the analysis of the sleep study and will meet you within a week to discuss the results and any potential treatments.