Professional Statements and Societal Positions Guidelines
American Academy of Sleep Medicine (AASM) 2005
AASM practice parameters indications for PSG and related procedures recommendations for PSG for non-respiratory indications:
- PSG and a MSLT performed on the day after the PSG are routinely indicated in the evaluation of suspected narcolepsy.
- PSG is not routinely indicated in cases of typical, uncomplicated, and non-injurious parasomnias when the diagnosis is clearly delineated.
- PSG is indicated when evaluating patients with sleep behaviors suggestive of parasomnias that are unusual or atypical because of the patient’s age at onset; the time, duration or frequency of occurrence of the behavior; or the specifics of the particular motor patterns in question.
- PSG is indicated in the following situations:
- Evaluating sleep related behaviors that are violent or otherwise potentially injurious to the patient or others; or
- In situations with forensic considerations (e.g., if onset follows trauma or if the events themselves have been associated with personal injury); or
- When the presumed parasomnia does not respond to conventional therapy.
- PSG is indicated when a diagnosis of PLMD is considered because of complaints by the patient or an observer of repetitive limb movement during sleep and frequent awakenings, fragmented sleep, difficulty maintaining sleep, or excessive daytime sleepiness.
- Intra-individual night-to-night variability exists in patients with periodic limb movement sleep disorder and a single study might not be adequate to establish this diagnosis.
- PSG is not routinely indicated to diagnose or treat RLS, except where uncertainty exists in the diagnosis.
- PSG is not routinely indicated for the diagnosis of circadian rhythm sleep disorders.
American Academy of Sleep Medicine (AASM) 2012
AASM published practice parameters for non-respiratory indications for PSG and MSLT in children. The following recommendations are for PSG and MSLT were made:
- PSG is indicated for children suspected of having PLMD for diagnosing PLMD.
- The MSLT, preceded by nocturnal PSG, is indicated in children as part of the evaluation for suspected narcolepsy.
- Children with frequent NREM [non‒rapid eye movement] parasomnias, epilepsy, or nocturnal enuresis should be clinically screened for the presence of comorbid sleep disorders and polysomnography should be performed if there is a suspicion for sleep-disordered breathing or periodic limb movement disorder.
- The MSLT, preceded by nocturnal PSG, is indicated in children suspected of having hypersomnia from causes other than narcolepsy to assess excessive sleepiness and to aid in differentiation from narcolepsy.
- The polysomnogram using an expanded EEG montage is indicated in children to confirm the diagnosis of an atypical or potentially injurious parasomnia or differentiate a parasomnia from sleep-related epilepsy.
- Polysomnography is indicated in children suspected of having RLS who require supportive data for diagnosing RLS.
Recommendations against PSG use:
- PSG is not routinely indicated for evaluation of children with sleep-related bruxism.
In 2017, AASM updated its practice parameters on PSG. The update made few recommendation changes to this review. For narcolepsy, the guidelines note that a clinical history, sleep diaries, PSG, and a MSLT are key items in the evaluation of the disorder.