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.