The clinical yield of repeated pediatric polysomnographies

Purpose: The role of repeat polysomnography (PSG) in children is poorly defined, with limited evidence guiding indications, timing, and expected diagnostic yield. The aim of this study was to characterize real-world use and yield of repeat PSGs, with emphasis on adenotonsillectomy (AT) status and background diagnoses. Methods: A retrospective observational study of children 0–18 years old who completed two or more PSGs at The Hadassah pediatric sleep laboratory between 2019 and 2023. Severity was classified using the AHI and a major change was defined as a transition between moderate-severe and no or mild sleep apnea. Analyses were performed for the entire cohort and stratified by AT status and by background diagnoses. Results: A total of 153 children, 4.4 ± 4.1 years old, 38% female, were included. Between the first and second PSG studies, 63.3% demonstrated a change in sleep apnea severity (p < 0.001), of whom 53.9% improved and 9.4% worsened. Overall, 48% experienced a major change in severity on the repeat study. Children who underwent AT showed higher rates of severity category change (74%) and major change (71%) compared with children managed without surgery (36%). Longitudinal trajectories differed by background diagnosis, with greater persistence of disease with Down syndrome, congenital heart disease, and neuromuscular disorders, and more variable patterns with prematurity and developmental delay. Conclusions: Sleep apnea severity frequently evolves over time in children undergoing repeat PSG. Findings support a selective, risk-based approach for repeat testing, emphasizing the need for objective reassessment in high-risk populations.