Making Sense of Pediatric Sleep Studies

If you treat pediatric patients, you’ve probably noticed that they rarely fit neatly into the boxes our protocols create. Growth is unpredictable, symptoms don’t always match the charts, and sometimes a child who has “finished” early treatment still walks into your office exhausted, snoring, or unable to focus in school.

This Advanced Implementation session, led by Dr. Katwa, leans directly into that reality. Instead of offering a polished set of rules, he reviews several cases, giving more insight into how orthodontics meets sleep medicine in growing patients.

Using real patient cases, he walks through the limitations of standard scoring, why many pediatric sleep studies are misread, and how symptoms often tell a more accurate story than the AHI alone. The conversation blends sleep physiology, growth patterns, and orthodontic mechanics, highlighting how to read sleep data in context rather than in isolation. For any dentist or orthodontist treating children with airway concerns, this presentation offers essential clarity on what sleep studies actually reveal and how to make sense of them during growth.

Key Takeaways:

• Many pediatric sleep studies are scored using adult criteria: This common error can drastically underestimate the severity of sleep-disordered breathing in children.
  

• The 3% desaturation rule is essential: Using a 4% rule, commonly applied to adults, can shift a child’s AHI from moderate to “normal,” missing meaningful clinical issues.
  

• Sleep studies can and should be rescored: If the scoring appears inconsistent with clinical symptoms, rescoring can reveal a far more accurate picture of the child’s sleep health.
  

• Symptoms often matter more than the AHI: Fatigue, poor behavior, snoring, mouth breathing and difficulty waking are powerful indicators, even when numbers look mild.
  

• Home sleep technologies can be useful but not diagnostic: Tools like SleepImage help track trends and parental concerns, but they cannot replace a properly scored PSG.
  

• Orthodontic treatment should be interpreted alongside sleep data: Expansion, mandibular advancement and growth changes must be viewed in the context of whether symptoms improve, worsen or remain unchanged.

The audience questions could have easily filled a second lecture!

Questions asked include:

• When do central apneas matter?

• How should we interpret fragmentation?

• When does a child need an MRI?

• How slow is “too slow” when activating an expander?

• Will slow activation limit options in Class III cases?

• How reliable are home devices when the signal quality is poor?

To watch the full video, join the Advanced Implementation Course with Dr. Yoon.

Live meeting sessions are held on the last Monday of every month at 6PM PT. All sessions are recording and available for replay.