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Volume 10 No. 08
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Accepted Papers

Scientific Investigations

Feasibility of Comprehensive, Unattended Ambulatory Polysomnography in School-Aged Children

Carole L. Marcus, M.B.B.Ch., F.A.A.S.M.1; Joel Traylor1; Sarah N. Biggs, Ph.D.2; Robin S. Roberts, M.Sc.3; Gillian M. Nixon, M.D.2,4; Indra Narang, M.D.5; Rakesh Bhattacharjee, M.D.6; Margot J. Davey, M.B.B.S.2,4; Rosemary S.C. Horne, Ph.D.2; Maureen Cheshire5; K. Jeremy Gibbons, B.Sc.5; Joanne Dix, B.Sc.N.3; Elizabeth Asztalos, M.D.7; Lex W. Doyle, M.D.8; Gillian F. Opie, M.B.B.S., M.D.9; Judy D'ilario3; Lorrie Costantini, B.A.3; Ruth Bradford1; Barbara Schmidt, M.D.3,10
1Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA; ; 2The Ritchie Centre and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; ; 3Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; ; 4Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia; ; 5Division of Respiratory Medicine, Hospital for Sick Children, Toronto, University of Toronto, Ontario, Canada; ; 6Section of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL; ; 7Department of Pediatrics, University of Toronto, Ontario, Canada; ; 8Department of Obstetrics and Gynaecology, the Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia, and Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; ; 9Mercy Hospital for Women, Heidelberg, and Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; ; 10Division of Neonatology, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA

Study Objectives:

Although unattended ambulatory polysomnography (PSG) is frequently performed in adults, few studies have been performed in children. The objective of this study was to evaluate the feasibility of comprehensive, ambulatory PSG, including electroencephalography, in school-aged children in the home environment.


A total of 201 children, born premature with birth weights of 500-1,250 grams, currently aged 5-12 years and living in Canada and Australia, underwent unattended ambulatory PSG.


PSG was initially technically satisfactory in 183 (91%) cases. Fourteen studies were satisfactory when repeated, resulting in an overall satisfactory rate of 197 (98%). Artifact-free signals were obtained for ≥ 75% of recording time in more than 92% of subjects, with the exception of nasal pressure, which was satisfactory for ≥ 75% of recording time in only 67% of subjects. However, thermistry signals were satisfactory for ≥ 75% of recording time in 92% of subjects, and some measure of airflow was present for ≥ 75% of recording time in 96% of subjects. Children slept very well, with a long total sleep time (534 ± 73 [mean ± SD] minutes), high sleep efficiency (92% ± 5%), and low arousal index (9 ± 3/h). Parents and children reported a high rate of satisfaction with the study.


This large, international study has shown that comprehensive, unattended, ambulatory PSG is feasible, technically adequate and well-tolerated in school-aged children when performed under research conditions. Further studies regarding the cost efficacy of this approach, and generalizability of the findings to a clinical population, are warranted.


Marcus CL, Traylor J, Biggs SN, Roberts RS, Nixon GM, Narang I, Bhattacharjee R, Davey MJ, Horne RS, Cheshire M, Gibbons KJ, Dix J, Asztalos E, Doyle LW, Opie GF, D'ilario J, Costantini L, Bradford R, Schmidt B. Feasibility of comprehensive, unattended ambulatory polysomnography in school-aged children. J Clin Sleep Med 2014;10(8):913-918.

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