BTS GuidelineBritish Thoracic Society guideline for diagnosing andmonitoring paediatric sleep-disordered breathingHazel JEvansNeilA GibsonJoanna Bennett,Samantha YS Chan5Johanna Gavlak,'Katharine Harman,Hasnaa Ismail-Koch,Ruth N Kingshott,Ross Langley,Andrew Morley,Kirstie S Opstad,3 Kylie Russo10Martin P Samuels,5.1 Hui Leng Tan,2 Daniel Tweedie,3 Michael Yanney4Andrea Whitney,On behalf of the BTS paediatric sleep disorders GuidelineDevelopment GroupAdditional supplementalSUMMARY OF RECOMMENDATIONS AND GOODThe Clinical Assessment Score-15 (CAS-15)material is published onlinePRACTICE POINTScombined sleep questionnaire and protocol-only.To view,please visit thejoural on line (http //dx.doiPlease note that sleep-disordered breathing(SDB)indriven'clinical assessment can be consideredorg/10.1136/thorax-2022-children without comorbidities is related to snoringfor diagnosing SDB in children.In contrast to218938.and upper airway obstruction and commonlythe SCR,the CAS-15 takes 10 min to completeFor numbered affiliations seereferred to as obstructive sleep apnoea(OSA).but has a reduced sensitivity of moderate.end of article.Sleep questionnaires should not be consideredDiagnosing sleep-disordered breathing infor diagnosing SDB in children under 2 years ofCorrespondence tochildren with suspected sleep-disorderedage,or if mild SDB is suspected.Dr Hazel J Evans;breathingHazel.Evans@uhs.nhs.ukSleep questionnaires,combined sleep questionnairesChildren with comorbiditiesand'protocol-driven'clinical assessments,sleep videoGood practice pointrecordings and sleep audio recordingsSleep questionnaires should not be consid-Children without comorbiditiesered for diagnosing SDB in children withRecommendationscomorbidities.The Sleep-Related Breathing Disorder scale ofthe PaediatricSleep Questionnaire(SRBD-PSQ),Pulse oximetry and CRSSwith a cut-ofof≥0.33，or Obstructive SleepChildren without comorbiditiesApnoea-18 item questionnaire (OSA-18),withRecommendationacut-off of≥0.60，can be considered for diagFor children with suspected SDB,pulse oximetrynosing moderate-to-severe SDB in children ofcan be considered as a first-line diagnostic testat least 2 years of age with no comorbidities.for SDB.If a test result does not fit the clinicalIf a test questionnaire is inconsistent with clin-picture,a higher level of investigation,such as aical features or if a higher degree of diagnosticCRSS,may be required(see also Good practicecertainty is required,further tests,such aspoints (GPPs)below).(Conditional)pulse oximetry,cardiorespiratory sleep studies(CRSS)or polysomnography (PSG),are recom-Good practice pointsmended.(Conditional)If pulse oximetry is normal,but there is suspi-Sleep questionnaires combined with acion of SDB,a CRSS may be useful to identify'protocol-driven'clinical assessment can bemild OSA.Sleep video recording may also beconsidered for diagnosing SDB in children,butconsidered to give a clearer picture.it should be noted that the sleep clinical recordIf pulse oximetry
