Sleep Studies In Children Research Articles

Prospective evaluation of the impact of multi-channel studies on treatment outcomes in children with sleep disordered breathing

There are significant variations in practice regarding the use of sleep studies in children with symptoms of sleep disordered breathing (SDB) prior to adenotonsillectomy. Current UK guidance recommends the selective use of sleep studies to confirm a diagnosis of obstructive sleep apnoea (OSA) when there is diagnostic uncertainty, in children with comorbidities, or to assess perioperative risk when severe OSA is suspected. We have developed a novel paediatric sleep service over the past decade based on the routine use of multi-channel sleep studies (MCSS) before adenotonsillectomy. We present the results of a prospective evaluation assessing the impact of our service on treatment outcomes.We conducted a prospective service evaluation of 49 children with SDB seen between July 2021 and August 2022. We used medical records and a sleep study database to determine treatment outcomes. Otolaryngologists completed a questionnaire before each multi-channel sleep study to help evaluate the impact of sleep study findings on surgical decision making.Questionnaire responses before MCSS showed that clinicians thought 66 % of children were ‘likely’, ‘very likely’ or ‘definitely’ would require surgery but only 54 % of children underwent surgery following their sleep study. We estimate that the use of MCSS was associated with a 21 % reduction in children undergoing surgery in this small sample.We conclude that our use of MCSS facilitates conservative management, allowing a significant reduction in the number of children with SDB undergoing surgery, but further validation of MCSS against polysomnography is required.

Is there room for in-hospital cardiorespiratory polygraphy sleep studies in children? – A real life practice

Is there room for in-hospital cardiorespiratory polygraphy sleep studies in children? – A real life practice

Home sleep studies in children with neurodisabilities: success rates and parental perception.

Home sleep studies in children with neurodisabilities have a high success rate (85.4% in our cohort), particularly in patients with limited mobility, have the advantage of reducing the burden of hospital admissions and are the family preferred option https://bit.ly/46t8aWN.

Con: Home Sleep Studies in Children - Are We There Yet?

Con: Home Sleep Studies in Children - Are We There Yet?

P090 Acceptability, Feasibility and Accuracy of Home Sleep Studies in Children with Neuromuscular Disorders

Abstract Introduction & Aims Nocturnal hypoventilation may indicate declining pulmonary function in children with Neuromuscular Disorders (NMD). Hypoventilation is diagnosed with polysomnography (PSG), but there are significant barriers to the routine performance of PSG in this population. Home-based sleep studies (HSS) may reduce burden on patients and their families. We assessed the acceptability, feasibility and diagnostic accuracy of HSS for children with NMD. Methods 11 participants, aged 5-15, underwent PSG. A HSS was conducted within two weeks for comparison that included measurement of transcutaneous carbon dioxide. Hypoventilation was defined as pCO2 >50mmHg for >25% of total sleep time. Acceptability was assessed by a survey completed by the families. Results Preliminary analysis shows HSS feasibility of 91% (10/11). Of 10 technically acceptable HSS, there was a concordant diagnosis in 9 (90%). Exploratory analysis shows higher total sleep time (529 vs. 431 minutes, p<0.05), slow wave sleep (132 vs. 99 minutes, p<0.05) and REM sleep (115 vs. 83 minutes, p<0.05) during HSS. Correlation was excellent between the percentage of total sleep time with pCO2 >50mmHg (κ=0.94, p<0.05) for PSG and HSS. 93% of families preferred HSS to laboratory PSG. Conclusion Preliminary analysis suggests home sleep studies that include transcutaneous carbon dioxide monitoring are feasible, acceptable and accurate when compared to PSG for diagnosing hypoventilation in children with NMD. These results imply that children may sleep better in the home environment. Further work is required to verify the diagnostic accuracy of home sleep studies in this group.

Sleep in children with refractory epilepsy and epileptic encephalopathies: A systematic review of literature.

Children with epilepsy have more sleep disorders compared to healthy children. The bidirectional interaction between epilepsy and sleep is not completely understood. However, disruption of sleep architecture during childhood may have consequences for cognitive development. As children with drug-refractory epilepsy often have intellectual disability, sleep disruption could be an important contributing factor in severity of their cognitive impairment. To better understand these interactions, sleep architecture in children with drug-refractory epilepsy and epileptic encephalopathies should be investigated. In this review, we conducted a systematic literature search on this topic. Articles that investigated sleep macro- and/or microstructure by means of electroencephalogram/polysomnography were included, as well as articles that used validated questionnaires. Sixteen articles were reviewed, eight of which used polysomnography. Only 2 articles examined sleep in children with epileptic encephalopathies. Consistent findings on measures of sleep architecture were a reduction in REM percentage and an increase in sleep fragmentation when comparing drug-refractory patients with non-refractory and healthy subjects. The findings on slow wave sleep were less clear. Studies with questionnaires unambiguously confirmed subjectively more sleep problems in children with drug-refractory epilepsy. This is the first review of literature in this patient population. More good quality sleep studies in children with drug-refractory epilepsy are warranted. The use of wearables in the home setting together with automatic sleep staging could provide more insights.

Screening Sleep Abnormalities in Children with Prader–Willi Syndrome: Challenges in the Indian Scenario

There is a high prevalence of sleep-related breathing disorders in the form of obstructive and central sleep apnea as well as spontaneous oxygen desaturation in children with Prader–Willi syndrome (PWS). Most cases are asymptomatic and if untreated go on to develop unfavorable neurodevelopmental, cardiovascular, and cerebrovascular outcomes. Hence, sleep study or polysomnography (PSG) is recommended in all children at the time of diagnosis as well as with the development of certain risk factors including symptoms of sleep apnea, before and after initiation of recombinant growth hormone (rGH) therapy. The use of rGH in children with PWS has been shown to improve central sleep apnea but also shown to be associated with worsening of OSA. PSG is ideally performed in a sleep laboratory. Various types of PSG devices are available depending on the biological parameters that are desired to be monitored. Sleep disorders in children are distinct from those seen in adults and have different diagnostic scoring criteria necessitating a trained pediatric sleep specialist to analyze the PSG recording. Through the clinical case vignette of a 14-year-old girl with PWS, severe obesity, and sleep disordered breathing, this review aims to highlight the need, timing, types, analysis, and interpretation of sleep studies in infants and older children with PWS, particularly in relation to rGH therapy. There is a paucity of literature on sleep studies in children with PWS in the local setting. Thus this review also suggests the need for adapting the existing Western guidelines for PSG in Indian children with PWS.

0987 Characterizing Scratch And Limb Movements In Atopic Dermatitis During Sleep

Abstract Introduction Children with atopic dermatitis (AD) experience significant sleep disruption due to nocturnal scratching. Our group has found distinct patterns of limb movements in contrast to control and PLMD patients. To expand on previous findings, our objective was to characterize timing and duration of scratch v. non-scratch movement in children with AD coincidentally undergoing polysomnography (PSG). Methods Retrospective chart review of PSG, video footage was synchronized with the EEG and limb electrode readings using a time/date generator and was then operationally classified as either scratching or non-scratching movement. Analysis of data was done using SPSS and groups were compared using an ANOVA. Results We analyzed four previously completed sleep studies in children with atopic dermatitis (1 female and 3 males), mean age years±SD 11.3±1.0, mean BMI±SD 21.9±7.1, mean AHI±SD 2.3±0.8. Average scratch duration was not significantly different by sleep stage, N1v.N2v.N3v.REM (mean scratch duration in seconds±SD= 9.0±1.5 v 6.3±3.2 v. 11.9±11.8 v. 6.3±7.3, respectively p=0.65). However, frequency of scratching events were more common during N2v.N1v.N3v.REM (mean scratching events±SD= 9.3±3.9 v 3.8±1.7 v. 4.3±4.3 v. 1.3±1.9, respectively p=0.02). Yet, given the duration of total time spent in sleep stages, minutes of scratching events occupied the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 3.9±0.9 v. 0.6±0.4 v. 0.4±0.2 v. 0.3±0.5, respectively, p&lt0.01). Interestingly, non-scratch related movements were not significantly different between sleep stages (p=0.2). However, non-scratch related movements trended to occupy the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 9.3±7.7 v. 2.1±1.6 v. 1.5±0.8 v. 1.9±1.4, respectively, p=0.05). Conclusion Our results suggest that scratching episodes in children with AD occur most commonly during N2 sleep, but occupy the largest % of N1 sleep. Future work will include comparing these limb movements to age and gender-matched allergic rhinitis patients. Support This study was unfunded.

Sleep-disordered Breathing

Sleep disordered breathing disorders in children are of a high clinical relevance. They do not only affect a large proportion of the children's lives in terms of time but they impact on the thriving, cardiovascular function and cognitive development. Different developmental factors have to be considered in the interpretation of sleep studies in children. Adeno-tonsillar hypertrophy is the most frequent reason for paediatric sleep disordered breathing, however the spectrum of aetiologies is very large. Syndromic cranio facial malformations and metabolic disorders are often associated with a very high risk of relevant sleep disordered breathing. Correct and child-oriented diagnostics are essential to enable adequate therapy.

Referral indications and prevalence of sleep abnormalities in children with early onset scoliosis.

This study describes the utility of overnight sleep studies in children with early onset scoliosis (EOS). Children with EOS have diminished respiratory reserve which is associated with abnormal breathing and sleep quality in children. Currently, there are no criteria for referral of these children to evaluate breathing during sleep or data on the use of sleep treatments as part of their supportive care. A review of the 159 patients with EOS who were followed at a single institution from 2003 to 2016 identified 68 who underwent overnight polysomnograms (PSGs). Sixty-five of 68 (96%) had elevated apnea-hypopnea index (AHI) and a majority (56%) were prescribed nighttime respiratory support. A majority of young children (< 5years) with PSG were referred for a history of snoring, apnea, or restless sleep; all 30 had abnormal PSGs. Twenty-seven (90%) had nighttime hypoxemia (nadir oxygen saturation values < 92%). Eighteen (60%) were referred to otolaryngology, of whom 11 (37%) subsequently underwent tonsil and/or adenoid removal. In older children (≥ 5years), those referred for PSGs had more severe restrictive chest wall disease [lower forced vital capacity (FVC) values] than those who were not sent for PSG. Correlation between FVC and apnea-hypopnea index, however, was not significant. Pre-operative coronal curve magnitude did not strongly correlate with nadir SaO2 or AHI in either age group. These results suggest that sleep studies are underutilized in the management of children with EOS. Inadequate and poor-quality sleep adversely affects growth, behavior, and cognitive function in children. This study suggests that screening for sleep abnormalities should be incorporated into assessment and treatment of more patients with EOS.

Predictors of Obtaining Polysomnography Among Otolaryngologists Prior to Adenotonsillectomy for Childhood Sleep-Disordered Breathing.

(1) To assess the predictors for obtaining polysomnography (PSG) in children undergoing adenotonsillectomy (AT) for sleep-disordered breathing, and (2) to estimate the adherence to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline recommendations for pre-AT PSG. This was a retrospective cohort study of children who were seen in the Pediatric Otolaryngology Clinic and underwent AT for sleep-disordered breathing over a 13-month period at a single tertiary care children's hospital. Patients with and without pre-AT PSG were compared using bivariate and logistic regression analysis to identify predictors for PSG. Electronic medical records were reviewed for demographic variables, medical comorbidities, and PSG data. Adherence to AAO-HNS guideline recommendations was estimated by calculating the proportion of patients who had a PSG among those who met the recommended criteria for pre-AT PSG. Mean age was 6.6 ± 3.6 years with 53% male. A total of 65 of 324 children (20%) underwent PSG prior to AT. The only factor significantly associated with pre-AT PSG was age 1 to 3 years (odds ratio 4.5, 95% confidence interval [2.2, 9.0], P < .001). Among patients who met AAO-HNS criteria for pre-AT PSG, 28 of 128 (20%) underwent PSG compared to 35 of 186 (19%) who did not meet criteria (odds ratio 1.0, 95% confidence interval [0.6, 1.9], P = .87). Among children who underwent AT, the only significant predictor of obtaining pre-AT PSG was age 1 to 3 years. The rate of adherence to the AAO-HNS guideline recommendations was low (20%), which represents an educational opportunity.

A cross-sectional analysis of daytime versus nocturnal polysomnographic respiratory parameters in cystic fibrosis during early adolescence

BackgroundIn Cystic Fibrosis (CF), early detection and treatment of respiratory disease is considered the standard for respiratory care. Overnight polysomnography (PSG) may help identify respiratory deterioration in young patients with CF. MethodsA prospective cohort study of 46 patients with CF, aged 8–12years, from a specialist clinic in a tertiary paediatric hospital. Daytime pulmonary function, shuttle test exercise testing and overnight PSG were studied. ResultsOf 81 children aged 8–12years, 46 (57%) agreed to participate. FEV1 (% predicted, mean 74.6%) was normal in 23 (50%), mildly abnormal in 12 (26.1%), moderately abnormal in 10 (21.7%) and severely abnormal in 1 (2.2%). Amongst sleep study parameters, FEV1 (% predicted) showed significant correlation with the respiratory rate (RR) in slow wave sleep (SWS), CO2 change in REM, baseline SaO2, and the arousal index (h−1). Backward, stepwise linear regression modelling for FEV1 (% predicted) included the entire group with a wide spectrum of clinical severity. From sleep, variables remaining in the multivariate model for FEV1 (F=16.81, p<0.001) were the RR in SWS (min−1) and the CO2 change in REM (p=0.003, and 0.014, respectively). When daytime tests were included, the variables remaining were RR in SWS and SD score for BMI (BMIsds) (F=18.70, p<0.001). ConclusionsRespiratory abnormalities on overnight sleep studies included elevated respiratory rates during SWS and mild CO2 retention in REM sleep, and these incorporated into a model correlating with FEV1 (% predicted). Thus, mild mechanical impairment of ventilation is evident on overnight sleep studies in children with cystic fibrosis although the significance of this finding will require further investigation.

Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children.

This study aimed to examine the effect of sleep state (rapid eye movement [REM] versus non-rapid eye movement [NREM]) and position (supine versus non-supine position) on obstructive respiratory events distribution in adolescent population (ages 12 to 18 y). This was a retrospective study that included 150 subjects between the ages of 12 to 18 y with an apnea-hypopnea index (AHI) > 1/h. Subjects using REM sleep-suppressant medications and subjects with history of genetic anomalies or craniofacial syndromes were excluded. The median age was 14 y with interquartile range (IQR) of 13 to 16 y, 56% of patients were males and the median body mass index (BMI) z-score was 2.35 (IQR: 1.71-2.59) with 77.3% of patients fulfilling obesity criteria. Respiratory obstructive events were more common in REM sleep. The median REM obstructive AHI (OAHI) was 8.9 events per hour (IQR: 2.74-22.8), whereas the median NREM OAHI was 3.2 events per hour (IQR: 1.44-8.29; p < 0.001). African American adolescents had more REM obstructive events with median REM OAHI of 13.2 events per hour (IQR: 4.88-30.6), which was significantly higher than median REM OAHI of 4.94 (IQR: 2.05-11.36; p = 0.004) in white adolescents. Obstructive events were more common in supine position with higher median supine OAHI of 6.55 (IQR: 4-17.73) when compared to median non-supine OAHI of 2.94 (IQR: 1-6.54; p < 0.001). This study shows that sleep related obstructive respiratory events in the adolescents (12 to 18 y of age) occur predominantly in REM sleep and in supine position.

Sleep studies in children on long-term non-invasive respiratory support

The aim of this study was to assess the impact of changes in respiratory support (RS) settings recommended after a titration polysomnography (PSG), in terms of daytime symptoms and quality of life. A retrospective chart review of all RS (CPAP and bi-level ventilation) titration studies was carried out at our tertiary paediatric sleep laboratory in the past 5 years. All patients with at least two studies in the past 5 years were included in the analysis. Parents completed the obstructive sleep apnoea (OSA)-18 and Paediatric Daytime Sleepiness Scale (PDSS) questionnaires on the night of each PSG. Results are presented as means (SD). A total of 42 patients (25 on CPAP and 17 on bi-level ventilation, age 11 (6) years) had 71 pairs of titration studies (41 CPAP and 30 bi-level). Changes in RS settings were recommended in 27 of 41 (65%) CPAP studies and 11 of 30 (36%) bi-level studies. Overall, changes were fully implemented by the treating physician in 55% of cases. There was an improvement in total OSA-18 score between studies in 48% of the paired CPAP studies and 65% of bi-level studies. OSA-18 scores improved in 47% of the studies where any recommended change had been implemented versus 0% of those where none of the recommended changes had been made (p=0.1). Titration studies frequently led to recommendations for a change in RS settings in these patients on long-term RS. Symptom scores were more likely to improve if recommendations for change were implemented by the time of the follow-up study.

A Comparison of Dexmedetomidine with Propofol for Magnetic Resonance Imaging Sleep Studies in Children

A Comparison of Dexmedetomidine with Propofol for Magnetic Resonance Imaging Sleep Studies in Children

The Role of Sleep Studies in Children Receiving Long Term Ventilation

Background: Follow-up sleep studies are recommended for children on long term ventilation (LTV), yet only one study has looked at their utility. While changes to ventilation are commonly needed, we wanted to identify: i) which measures in the sleep study showed abnormalities, and ii) the frequency and nature of changes made to ventilator settings. Method: LTV sleep study results over 5.8 years were collated. Recordings included: SpO2, ECG, heart rate, chest and abdominal movements, transcutaneous and end-tidal CO2, airway pressure and video (Visilab 3, Stowood Medical, Oxford). Data were obtained on: oxygenation, CO2, patient-ventilator synchrony, variance of airway pressures from those prescribed, pressure waveform, and outcome.Results: There were 153 studies from 51 patients: age range 0.1 to 19.8 years (median 11.1). Conditions included: congenital central hypoventilation syndrome (15), sleep related upper airway obstruction (13), neuromuscular disease (11), severe neurodisability (5), craniofacial abnormalities (3), and others (4). Abnormal findings existed in 134/153 (88%) studies. Sixty five out of 152 (43%) had abnormalities in gas exchange, including low baseline SpO2 in 53, episodic hypoxaemia in 44, and raised CO2 in 33. Seventeen (11%) had inadequate pressures or synchrony: pressures were satisfactory in 79 / 92 with data; synchrony was seen in 90/94 studies. Changes were made in 47 (31%); an increase in ventilation in 32 and reduction in 15.Conclusion: This confirms a place for assessing blood gas exchange, airway pressures and adequacy of synchrony in children receiving LTV. Further work needs to identify the appropriate interval for review studies.

Retropharyngeal Lymph Nodes in Children: A Common Imaging Finding and Potential Source of Misinterpretation

The retropharyngeal lymph nodes are the least well-described portion of the Waldeyer ring. Originally described as occurring in medial and lateral groups, reports have described only the presence of lateral nodes in children. We have seen cases of MRI sleep studies in children with obstructive sleep apnea (OSA) in which lateral and medial retropharyngeal lymph nodes are present and have been misinterpreted. Our purpose is to describe the frequency and appearance of retropharyngeal lymph nodes in children with and without OSA. Axial and sagittal T2-weighted MRI scans were reviewed in 150 children with OSA and 150 control subjects without OSA, who underwent imaging for other indications. The presence, size, and location of the retropharyngeal lymph nodes were evaluated. Retropharyngeal lymph nodes were evaluated for frequency of medial nodes, frequency of lateral nodes, size as indicated by the anterior-to-posterior diameter, laterality (bilateral or unilateral), and superior-to-inferior location compared with the cervical vertebral body level. Analyses were performed using the chi-square or Fisher's exact test (for categorical data) and generalized linear model or two-sample Wilcoxon's Mann-Whitney test (for continuous data). Lateral retropharyngeal lymph nodes were common in both children with OSA (137/150 [91.3%]) and children without OSA (146/150 [97.3%]). Medial retropharyngeal lymph nodes occurred not uncommonly in both children with OSA (32/150 [21.3%]) and those without OSA (26/150 [17.3%]). Lateral retropharyngeal lymph nodes were more commonly bilateral (95% CI, 88.4-97.4%; p < 0.0001) and located at the skull base (C1) or C1-C2 level (99%; p < 0.0001). Medial retropharyngeal lymph nodes were more commonly unilateral (95% CI, 71.9-84.6%; p < 0.0004) and located at the C2-C3 level (95% CI, 78.13-84.62%; p < 0.0001). There were no statistically significant differences in the proportion of medial or lateral retropharyngeal lymph nodes in the OSA group compared with the control group. Retropharyngeal lymph nodes are seen commonly in children in both lateral (95% CI, 91.3-97.3%) and medial (95% CI, 17.3-21.3%) locations. Media nodes are present more frequently than previously described. Such nodes occur almost equally frequently in populations with and without OSA. Retropharyngeal lymph nodes should be considered normal in children and not be interpreted as abnormal or misdiagnosed.

Prenatal and Perinatal Complications: Is It the Link Between Race and SES and Childhood Sleep Disordered Breathing?

Recent evidence has suggested that low socioeconomic status (SES), race, prematurity, and maternal smoking during pregnancy are associated with childhood sleep disordered breathing (SDB). We investigated (1) the association of SDB with a wide range of risk factors, including prenatal and perinatal complications; (2) the association of these complications with SES and race; and (3) the association of SDB with developmental milestones. Six hundred thirteen school-aged children (105 clinically referred and 508 community control subjects) underwent overnight polysomnography and had a complete history and physical examination. A comprehensive child development questionnaire was completed by a parent. We compared clinically referred children with SDB to population-based control children without SDB from The Penn State Children's Cohort. Maternal smoking during pregnancy; maternal age and weight gain during pregnancy; prenatal complications, such as maternal high blood pressure and gestational diabetes; perinatal complications related to prematurity; delayed motor milestones; race and SES were significantly associated with the presence of childhood SDB. Most of the risk factors became nonsignificant when analyses controlled for race and SES. Delayed motor milestones remained significantly associated with SDB after controlling for race and SES. These data suggest that there is a significant association between children who experience prenatal or perinatal distress and the development of moderate to severe childhood SDB. SES and race may be mediating the impact on SDB through increased prenatal and perinatal risks. The significant delay in motor milestones suggests that prenatal and perinatal distress may result in neurologic insult, which could influence the development of SDB in later childhood.

A Comparison of Dexmedetomidine With Propofol for Magnetic Resonance Imaging Sleep Studies in Children

Survey of Anesthesiology: June 2010 - Volume 54 - Issue 3 - p 127-128 doi: 10.1097/01.SA.0000370469.99015.d4

A Comparison of Dexmedetomidine with Propofol for Magnetic Resonance Imaging Sleep Studies in Children

Magnetic resonance imaging (MRI) sleep studies can be used to guide management of children with obstructive sleep apnea (OSA) refractory to conservative therapy. Because children with OSA are sensitive to the respiratory-depressant effects of sedatives and anesthetics, provision of anesthesia for imaging studies in this patient population can be challenging. Dexmedetomidine has been shown to have pharmacological properties simulating natural sleep with minimal respiratory depression. We hypothesized that, compared with propofol, dexmedetomidine would have less effect on upper airway tone and airway collapsibility, provide more favorable conditions during dynamic MRI airway imaging in children with OSA, have fewer scan interruptions, and require less aggressive airway interventions. In this retrospective descriptive study, we reviewed the records of 52 children receiving dexmedetomidine and 30 children receiving propofol for anesthesia during MRI sleep studies between July 2006 and March 2008. Documentation of the severity of OSA by overnight polysomnography was available for 67 of the 82 subjects, who were analyzed separately. Data analyzed included demographics, severity of OSA, comorbidities, hemodynamic changes, use of artificial airways, additional airway maneuvers, and successful completion of the MRI scan. Demographics, OSA severity by polysomnography, anesthetic induction, and baseline hemodynamics were comparable in both groups. An interpretable MRI sleep study was obtained for 98% of children in the dexmedetomidine group and 100% in the propofol group. Of 82 children, MRI sleep studies were successfully completed without the use of artificial airways in 46 children (88.5%) in the dexmedetomidine group versus 21 children (70%) in the propofol group (P = 0.03). An artificial airway was required to complete the study in five children (12%) in the dexmedetomidine group versus nine children (35%) in the propofol group (P = 0.06). Additional airway maneuvers (chin lift and shoulder roll) were required to complete the study in one child (2%) in the dexmedetomidine group and three children (10%) in the propofol group (P = 0.14). Children in the dexmedetomidine group experienced reductions in heart rate, whereas those in the propofol group experienced reductions in arterial blood pressure; these reductions were statistically, but not clinically, significant. Dexmedetomidine provided an acceptable level of anesthesia for MRI sleep studies in children with OSA, producing a high yield of interpretable studies of the patient's native airway. The need for artificial airway support during the MRI sleep study was significantly less with dexmedetomidine than with propofol. Dexmedetomidine may be the preferred drug for anesthesia during MRI sleep studies in children with a history of severe OSA and may offer benefits to children with sleep-disordered breathing requiring anesthesia or anesthesia for other diagnostic imaging studies.