Minimum Age for Polysomnography in Children with Suspected OSA
Polysomnography can be performed at any age from birth onward, but formal guideline recommendations for its use in suspected obstructive sleep apnea begin at age 2 years. 1
Guideline-Specified Age Parameters
The American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline explicitly addresses PSG for children aged 2 to 18 years with sleep-disordered breathing who are candidates for tonsillectomy. 1 The guideline specifically states it "does not apply to children younger than age 2 or older than age 18." 1
However, this age cutoff reflects the scope of that particular guideline rather than a technical limitation of the test itself.
PSG Can Be Performed Below Age 2
Despite the guideline's scope limitation, polysomnography is both technically feasible and clinically indicated in infants and children under 2 years:
The American Academy of Sleep Medicine recommends PSG in infants with Prader-Willi syndrome at the time of diagnosis to rule out central apnea, with continued monitoring approximately every 6 months for those with central adrenal insufficiency. 1
PSG is indicated when clinical evidence suggests sleep-related breathing disorders in infants who have experienced an apparent life-threatening event (ALTE). 2
Infants 3 months or older can be scored using standard pediatric sleep staging that includes N1, N2, and N3 sleep stages, as sleep spindles are consistently present at this age. 3
Studies have demonstrated technical feasibility of PSG in children ranging from newborn to 15 years, with 93% technically acceptable recordings when sensors are placed by trained professionals. 1
Critical Clinical Context
Children under age 3 with documented OSA on PSG require inpatient overnight monitoring after tonsillectomy due to higher perioperative risk. 1, 4 This recommendation underscores that PSG results in very young children have direct clinical implications for surgical management.
Children under age 2 with any signs of obstructive sleep-disordered breathing should be referred for polysomnography according to referral guidelines. 4
Common Pitfalls to Avoid
Do not assume PSG cannot be performed in infants or very young children—the technology works at any age when properly applied by trained personnel. 1
Clinical diagnosis alone is a poor predictor of OSA severity in children of all ages, making objective testing essential even in the youngest patients. 4
Home sleep apnea testing is not recommended for diagnosis of OSA in any child under 18 years, regardless of age. 1