Abstract Rationale Pediatric polysomnography (PSG) is the gold standard for diagnosing sleep-disordered breathing. However, the absence of standardized triage criteria for PSG reporting leads to variable response times and potential adverse outcomes. To address this, our pediatric sleep center implemented a PSG reporting protocol to standardize identification and escalation of significant findings. Our study aim was to describe the triage criteria, reporting timelines, and resulting management plans. Methods With Institutional Review Board approval, we retrospectively reviewed patients who underwent PSG at The Hospital for Sick Children (Toronto, Canada) between July 1 and September 30, 2025, and met urgent or critical reporting criteria developed based on internal consensus, which included input from sleep physicians, nurse practitioners, respiratory therapists and sleep technologists. Demographic, clinical, PSG, and management data were extracted from electronic records. Studies were performed and reported per American Academy of Sleep Medicine guidelines. Critical and urgent criteria (Table 1) required reporting within 1 and 3 days, respectively. Results During the study period, 373 PSGs were performed; 44 (11.8%) met urgent and/or critical reporting criteria: 34 (77.3%) were deemed urgent and 10 (22.7%) were identified as critical. Median age was 5.6 years (IQR 2.8-10.1); 24 (54.5%) were male. Underlying diagnoses included respiratory 23 (52.3%), central nervous system 13 (29.5%), neuromuscular 5 (11.4%), and 3 (6.8%) no reported diagnosis. The most frequent criterion met were: obstructive sleep apnea, 25 (56.8%), nocturnal hypoventilation, 8 (18.2%), abnormal electroencephalogram (EEG) 7 (15.9%), oxygen desaturations, 5 (11.4%), central sleep apnea, 5 (11.4%), ventilator adjustment 4 (9.1%), abnormal electrocardiogram (ECG) 2 (4.5%), and positive multiple sleep latency test (MSLT) 1 (2.3%). Of the 44 studies, 30 (68.2%) met 1 criterion, 13 (29.5%) met two and 1 (2.3%) met three. The mean (SD) time to report critical studies was 0.5 (0.6) days, and 3.2 (2.4) days for urgent studies. 12 urgent studies were out of window. Post-PSG interventions included urgent outpatient referral 29 (65.9%), expedited clinic review 11 (25%), hospital admission 8 (18.2%), and emergency department visit 5 (11.4%). Conclusion Implementation of a PSG reporting protocol was feasible and helped facilitate timely clinical interventions. We are working to ensure all studies are reported as per protocol moving forward. Standardizing pediatric urgent and critical reporting criteria is an opportunity to enhance patient safety and implementation across pediatric sleep centers is a future direction. This abstract is funded by: None
Alturkistani et al. (2026) studied this question.