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First night effect for polysomnographic data in children and adolescents with suspected sleep disordered breathing
  1. S L Verhulst1,
  2. N Schrauwen1,
  3. W A De Backer2,
  4. K N Desager1
  1. 1Department of Pediatrics, University Hospital of Antwerp, Belgium
  2. 2Department of Respiratory Medicine, University Hospital of Antwerp, Belgium
  1. Correspondence to:
    Dr S Verhulst
    University of Antwerp, Department of Pediatrics, Campus Drie Eiken, Office T4.27, Universiteitsplein 1, 2610 Wilrijk, Belgium; stijn.verhulst{at}ua.ac.be

Abstract

Aims: To assess the presence of a first night effect (FNE) in children and adolescents and to examine if a single night polysomnography (PSG) is sufficient for diagnosing obstructive sleep apnoea syndrome (OSAS).

Methods: Prospective case study of 70 patients (group 1: 2–6 years, n = 22; group 2: 7–12 years, n = 32; group 3: 13–17 years, n = 16) referred for OSAS. Diagnostic criteria for OSAS: one or more of the following: (1) obstructive apnoea index (OAI) ⩾1; (2) obstructive apnoea hypopnoea index (oAHI) ⩾2; (3) SaO2 ⩽89% in association with obstruction.

Results: In all age groups, but mainly in the oldest children, REMS increased during the second night, mainly at the expense of stage 2 sleep. The first night PSG correctly identified OSAS in 86%, 91%, and 100% of the children for groups 1, 2, and 3 respectively. This represents 9% false negatives for OSAS when only the first night PSG was used. All cases missed had mild OSAS, except for one with oAHI >5 on night 2. There were also seven patients with OSAS on night 1 but with a normal PSG on night 2: all had oAHI <5.

Conclusion: There is a FNE in children and adolescents. A single night PSG is sufficient for diagnosing OSAS, but in cases with a suggestive history and examination and with a negative first night, a second night study might be advisable.

  • AHI, apnoea hypopnoea index
  • FNE, first night effect
  • OAI, obstructive apnoea index
  • oAHI, obstructive apnoea hypopnoea index
  • OSAS, obstructive sleep apnoea syndrome
  • PS, primary snoring
  • PSG, polysomnography
  • REML, REM sleep latency
  • REMS, rapid eye movement sleep
  • SL, sleep latency
  • SaO2, oxygen saturation
  • SDB, sleep disordered breathing
  • SPT, sleep period time
  • TIB, time in bed
  • TST, total sleep time
  • first night effect
  • polysomnography
  • obstructive sleep apnoea
  • sleep disordered breathing

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Footnotes

  • Published Online First 13 December 2005

  • Competing interests: none

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