Center for Pediatric Sleep Disorders

Diagnosing the problem

At our Center for Pediatric Sleep Disorders, a specialist in pediatric sleep medicine will meet with your family to take a detailed history of your child’s symptoms and perform a physical examination.

Tests performed

If we suspect your child has certain problems (such as sleep apnea, nocturnal events or narcolepsy), we may order additional tests.

Since we may need to study how your child sleeps in order to diagnose her problem, we may recommend that you and she spend a night in our laboratory for a sleep study (also called a polysomnogram). This test is used to assess sleep quality and to identify sleep disorders. It records brain waves, eye movements, muscle tone, respiration, heart rate and rhythm and leg movements.

We also may recommend a daytime nap study (Multiple Sleep Latency Test, or MSLT). This test records a child's brain and body activity at repeated times across the day to measure how fast the child can fall asleep and to identify the type of sleep attained. The MSLT provides a measure of sleepiness and helps make specific sleep-disorder diagnoses.

Other tests may include:

• Maintenance of Wakefulness Test (MWT). This test measures sleepiness by recording a child's brain and body activity (typically brain waves, eye movements, muscle tone, heart rate and rhythm and leg movements) at repeated times across the day.
   
• Actigraphy, a noninvasive test that uses a sensor to measure a child's activity and rest periods
   
• Overnight oximetry, a simple test that uses a plastic clip on the child's finger to track heart rate and blood oxygen content during sleep
   
• Continuous Positive Airway Pressure (CPAP) filtration

Treating and managing sleep disorders

In most situations, we can help you normalize your child’s sleep by using behavioral interventions. We will work with you and your child and suggest strategies to normalize her sleep—for example, by helping you teach your child more appropriate sleep-related habits, correcting problematic sleep schedules and adjusting nighttime feeding schedules.

If your child has certain sleep-related medical disorders, we may prescribe medications that promote sleep and wakefulness. We may suggest adjustments in other medications your child is taking, as well.

In obstructive sleep apnea, your child’s breathing is partially blocked during sleep. The most frequent cause in children is enlargement of the adenoids and tonsils, and we may seek the opinion of one of our surgical colleagues in Otolaryngology (ear, nose, and throat) for possible removal of the enlarged tissue (adenotonsillectomy). Because deposits of fat in the airway are a common cause of breathing troubles in obese children, weight loss may be an important part of treatment; we may refer your child to Children’s Optimal Weight for Life (OWL) Program. 

For obstructive sleep apnea we sometimes prescribe continuous positive airway pressure (CPAP), in which your child wears a mask at night. Air blows through the mask to keep his airway open while he sleeps.

In some cases, we may prescribe specific medications to manage excessive daytime sleepiness.

In special circumstances, we may refer your child to other physicians for help in managing sleep problems associated with other respiratory disorders or neuromuscular disease, developmental disorders, abnormalities in facial structure and seizures.

Your visit

These resources can help you and your child get ready for your appointment at our Center for Pediatric Sleep Disorders at Boston Children’s Hospital.

Logging your child’s sleep

Making a record of your child’s sleep can be a big help in diagnosing problems. Here is a sleep chart (pdf) you can use. If you fill out the chart for a couple of weeks before you come in for a consultation, it will help us understand your child’s sleep. You may even start to spot problematic sleep patterns before you come to your appointment.

Sleep studies

If you are coming to one of our laboratories for a sleep study, you and your child probably have a lot of questions about what to expect. In this Sleep study walkthrough, your family can follow a patient and his dad as they complete a sleep study.

This list of Frequently asked questions regarding the Sleep Laboratory (pdf) explains the different kinds of tests we do at the Sleep Labs. Please review it a few days before your child’s test so that you can know how to get ready and what to bring.

You can also learn more about sleep studies (also called “polysomnography”) here.

If you need to cancel your appointment for a sleep study, please contact us immediately. On weekdays between 8 a.m. and 4 p.m., please call the scheduling office at 781-216-2570. At other times, call the page operator at 617-355-6363 and ask to page the chief technologist for the Sleep Lab where your appointment is scheduled (Boston Lab page #0804; Waltham Lab page #6638).