BTS publishes new Guideline on Paediatric Sleep-disordered Breathing

Today the British Thoracic Society (BTS) publishes its new Guideline for Diagnosing and Monitoring Paediatric Sleep-disordered Breathing (SDB). Focusing on investigative techniques that are widely available within the UK, the Guideline provides recommendations and guidance on the differing methods used for diagnosing and monitoring sleep-disordered breathing in children.

Paediatric SDB generally refers to breathing difficulties during sleep and is commonly caused by enlarged tonsils and adenoids, obesity, or underlying conditions such as genetic disorders, neuromuscular disorders or problems with the lower jaw or tongue. The Guideline focuses on the wider definition of SDB, which affects between 1% to 3% of children, rather than addressing specific sleep disorders individually.

On the importance of the Guideline, Guideline co-chair Dr Hazel Evans, said,

“This guideline was important because the absence of an evidence-based guideline has resulted in a lack of standardised care for children presenting with symptoms of SDB and a tendency towards onwards referral to tertiary diagnostic services. There was a real need to determine the role of a range of existing technologies in the diagnosis of SDB so that service delivery could be addressed within the wider NHS.”

The diagnostic techniques investigated include sleep questionnaires, pulse oximetry with and without carbon dioxide (CO₂) monitoring, and cardiorespiratory sleep studies (CRSS). The diagnostic techniques are compared against the accepted gold standard polysomnography (PSG). The guideline evaluated technical considerations when undertaking sleep studies in particular the importance of excluding artefact due to motion as well as the minimum length of sleep study required and the factors that affect variation in results from night to night. The diagnostic accuracy of studies undertaken in the home setting was also studied compared to studies undertaken in hospital.

Dr Neil Gibson, co-chair, further elaborated,

“We hope the recommendations we make will provide guidance to clinicians on the strengths and limitations of the tests available and encourage the further development of diagnostic and treatment services across the UK. This will greatly benefit the children and families affecting by breathing problems during sleep.”

After reviewing the strengths and weaknesses of the sleep study types above, the Guideline concludes that the techniques investigated can adequately be used for diagnosing and monitoring SDB in most children, but the appropriateness of their use depends on the specifics of the child. PSG is in general not required to diagnose SDB. Implementing the recommendations in practice has potential to reduce significant burden on health system budgets and patient accessibility and treatment trepidation, allowing diagnosis and monitoring to be done more locally or at home.
Chair of BTS, Dr Paul Walker, said,

“BTS guidelines try to address important areas of clinical practice with the aim of improving the quality of diagnosis, management and service delivery. We hope this guidance about paediatric sleep-disordered breathing, a previously often overlooked area, will contribute to these improvements to the benefit of the children and young people who are affected.”
 
The new Guideline for Diagnosing and Monitoring Paediatric Sleep-disordered breathing is available here.