Section I - Diagnosis and Medical Management
Physiologic Studies
Physiological studies are not meant to be used as screening tools in asymptomatic patients or patients with the following conditions: asymptomatic siblings of SIDS, AOP, AOI, or ALTE; family history of adult sleep apnea; the brain injured infant; parental anxiety caused by knowledge of a friend or relative with a symptomatic and/or monitored infant; infants with GER but no symptoms of apnea; and infants recovered from known causes of apnea who are no longer symptomatic (e.g. sepsis, seizures, RSV, influenza, upper respiratory infections). Physiologic studies can be classified as simple or complex.
Simple
Memory Monitor Download (Download): A printed report from a cardiorespiratory memory monitor which documents compliance (dates and times of use), patient alarm settings and alarm summaries. The data collected should include QRS complexes, heart rate trends and respiration waveforms. Other data may also be collected including SpO2 and pulse waveform. This is not a continuous recording.
Pneumocardiogram or Pneumogram (PCG): A continuous two channel recording consisting of a respiratory waveform and ECG. The pneumogram is obsolete and should not be used in the diagnosis or management of apnea.
Complex
Multichannel Study (greater than 4 channels): A continuous and simultaneous recording of the respiratory wave form, QRS complex, cardiac trend, oxygen saturation, airflow, and sometimes data from a pH probe. Usually 4 to 12 hours of data is collected for evaluation. The indications for this type of study are to aid in documenting and determining the significance of apnea and/or bradycardia episodes, to differentiate central, mixed, or obstructive apnea, and to rule out apnea associated with gastroesophageal reflux (GER). The role of the multichannel study is to assist the diagnostician in clarifying the significance and etiology of the event. Ideally this should be an observed study, although simultaneous video monitoring can be used instead.
Polysomnography (Sleep Study): A continuous and simultaneous multichannel recording which consists of EEG, EOG, EMG, EKG, oximetry and respiratory parameters (nasal or oral airflow and respiratory effort). Additional channels may be added including video monitoring. This study is performed by a Registered Polysomnographic Technologist or an experienced, specifically trained health care professional who continuously observes the infant. Ideally, a minimum of 6 hours of data is collected for evaluation. The indications include ALTE, hypoventilation, hypopneas, persistent apneic episodes, previous abnormal physiological studies, and the diagnosis of obstructive apneas.