Sweet dreams at home: A review of paediatric domiciliary sleep studies.

INTRODUCTION

Traditional in-laboratory level 1 polysomnography remains the gold standard to diagnose paediatric sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA). However, in-laboratory tests present significant barriers, including long waitlists, limited accessibility, particularly for rural/remote families and burdensome hospital stays. In contrast, domiciliary sleep studies have become widely adopted in adult populations. However, similar uptake in paediatrics remains limited due to a lack of robust validation and standardisation. This review explores the current evidence for domiciliary sleep studies in children, highlighting their potential to enhance timely diagnosis and management of SDB while also exploring areas for improvement.

METHODS

A structured MEDLINE search identified 16 key articles that explored various home-based diagnostic methods including polysomnography, pulse oximetry, transcutaneous carbon dioxide (CO2) monitoring, as well as novel limited-channel commercial devices. Results suggest that while home-based polysomnography (level 2) has high feasibility and parental preference, simpler modalities like pulse oximetry and level 4 approaches often underdiagnose OSA due to limited apnoea detection. Commercial devices, though better tolerated, tend to have reduced diagnostic accuracy.

RESULTS AND DISCUSSION: Critical themes discussed include parental compliance, device accuracy (especially apnoea-hypopnoea index measurement), and implementation challenges. Recommendations include multi-night testing, minimising equipment complexity, involving trained technicians or providing thorough parental education, and refining device sensitivity.

CONCLUSION

This review underscores the need for further paediatric-specific validation of home-based sleep study technologies. Optimising domiciliary sleep diagnostics may help alleviate healthcare congestion and improve clinical outcomes for children with sleep disorders.