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Editor,—If sleep studies are worth doing, they are worth doing well. The study of sleep disordered breathing is another area of paediatrics that the UK has stumbled to embrace.1 2 Sleep medicine has exponentially increased in adults in recent years, yet in paediatrics many questions remain unanswered.
Although van Someren and colleagues made a valiant attempt to answer an important question,3 they did so by assessing clinical scores in relation to a standard which was far from gold and, as such, accuracy could not be determined, only inferred. Clinical scores or simple oximetry are limited in their ability to identify obstructive sleep apnoea (OSA), as they are able to identify significant OSA but not mild to moderate cases.4 5 Data is now accumulating that even mild OSA may be associated with significant neurocognitive morbidity in children.6 7 Full polysomnography is the current gold standard. The Visilab has not been satisfactorily validated against full polysomnography, and the results presented in van Someren and colleague's paper showed a discrepancy in two of 10 simultaneous recordings (a 20% error rate) with important differences in mean oxygen saturation between the two systems (93%v 95%). It is true that full polysomnography may not be required in all children for the diagnosis of OSA, but this process should be one of working down from a gold standard rather than edging up towards it. The arguments used by van Someren and collegues against the use of full polysomnography are weak. Children in dedicated sleep areas tolerate full polysomnography well: in the 54 full polysomnographic OSA studies performed in the past six months in this unit, sleep efficiency was a mean of 90% (SD 8%), which includes children with frequent wakening as a result of their OSA!
In recent years, centres in both North America and Australia have dedicated significant funding to paediatric sleep laboratories and the appropriate training of both nursing and medical staff through specific specialist training criteria; the UK sadly lacks such support. With the exception of one paediatric unit (concentrating on sleep in rare disorders) sleep related research in the UK is linked to adults centres. UK paediatrics needs a sleep medicine wake up call, so that standards can be set from gold.
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