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For professionals

This page has information for clinicians who want to refer to the children's sleep service at Evelina London.

Referral checklist

Our sleep service referral checklist (PDF 1.29Mb) helps us decide if we can accept a patient for referral, fast track if necessary, and move into the most appropriate investigation and management pathway as early as possible.

Diagnostic service information for professionals

The department offers a number of different diagnostic investigations. 

Diagnostic investigations

Paediatric actigraphy study

A specialised investigation used to assess total sleep time and sleep pattern in the home environment.

It can only be requested following discussion with a paediatric sleep consultant (either Dr Farquhar or Professor Gringras).

Waiting time for this investigation is usually four to six weeks.

Paediatric cardiorespiratory sleep study

An inpatient overnight cardiorespiratory sleep study primarily to assess for sleep disordered breathing.

As well as video recording, it measures a number of parameters including:

  • oxygen saturation
  • carbon dioxide levels
  • heart rate
  • airflow
  • thoracic
  • abdominal movements, position and snore.

These studies are usually carried out in the in the Children's Sleep Centre, South Wing, St Thomas' Hospital. A small number are carried out in the inpatient sleep beds on Savannah Ward, Evelina London Children's Hospital.

For most patients where sleep disordered breathing is the principal concern, and where oximetry alone is not sufficient, this is an appropriate formal sleep study to request.

Waiting time for this investigation is usually four to six weeks.

Paediatric inpatient O/ CO2study

This is an inpatient overnight limited respiratory and measures only oxygen saturation, carbon dioxide level and heart rate.

These studies are predominantly carried out in Mountain Ward at Evelina London, but can be carried out elsewhere in the hospital. They are usually most appropriate for children who are admitted to Evelina London for other reasons.

These studies must be discussed with a respiratory consultant before being requested – prioritisation and review of studies is usually carried out by the consultant on service for paediatric respiratory medicine. 

Paediatric outpatient (home) oximetry study

This is an outpatient limited respiratory sleep study which measures only oxygen saturation and heart rate.

It is usually carried out over two nights at home. We offer a same-day 'walk-in' service to the Children's Sleep Centre at St Thomas' Hospital for this test from selected outpatient clinics – children can usually be sent straight from clinic to pick up an oximeter to take home the same day.

Paediatric polysomnography (PSG)

This is a specialised inpatient overnight sleep study and is the 'gold standard' level of sleep study.

In addition to parameters measured in a cardiorespiratory sleep study, PSG also includes a limited EEG montage which allows identification of sleep stages and a more subtle assessment of sleep quality to be made.

These studies are carried out predominantly in the Children's Sleep Centre, South Wing, St Thomas' Hospital. A small number are carried out in the inpatient sleep beds on Savannah Ward, Evelina London Children's Hospital.

PSG can only be requested following discussion with a paediatric sleep consultant (either Dr Farquhar or Professor Gringras).

Waiting time for this investigation is usually four to six weeks.

As PSG uses a limited EEG montage, it is not an investigation for assessment of possible nocturnal seizures. For this a combined PSG and video EEG telemetry needs to be requested via the EEG department, not the sleep service.  

This can be requested (by Evelina London clinicians) via the EEG video telemetry EPR request form by ticking the combined sleep study option.

Paediatric polysomnography with multiple sleep latency test

This is a highly specialised investigation which in addition to overnight PSG assesses daytime sleepiness.

It is principally a diagnostic test for narcolepsy, though can have other uses.

PSG with MSLT can only be requested following discussion with a paediatric sleep consultant (either Dr Farquhar or Professor Gringras).

Waiting time for this investigation is usually four to six weeks.

Sleep studies

Locations

Inpatient sleep studies are carried out either within Evelina London Children's Hospital, or in the Children's Sleep Centre which is located on the 1st floor, South Wing, staircase D, St Thomas' Hospital.

The Children's Sleep Centre is a dedicated two bedroom unit which is only used for sleep studies. It is staffed overnight by specialist paediatric sleep physiologists.

For children to have studies in the Sleep Centre, a parent/carer must be resident with their child for the night. The parent/carer must carry out all routine care, including medical treatment, which the child would usually have at home overnight.

Children on respiratory support, including nocturnal oxygen and non-invasive ventilation, can have studies performed in the Sleep Centre, but this will usually require prior discussion and confirmation with one of the consultants or Jane Orgill in the first instance.

If children have complex medical needs, require significant manual handling (eg hoisting) or parents are not able to do normal routine care for their child overnight, the sleep study will be carried out in the one of the two dedicated inpatient sleep study beds on Savannah Ward in Evelina London. Please note that a parent is still required to be resident with their child for the study. 

Final decision regarding the most appropriate location for any study to be carried out will be made by the sleep team.

Queries regarding appointments and children's suitability for studies in the Sleep Centre or Savannah Ward can be discussed with the Children's Sleep Centre administrator.

Reporting

All studies are analysed by sleep physiologists and then commented on by one of the paediatric sleep consultants; inpatient O2/CO2studies are usually reviewed by the on-call respiratory consultant.

Urgent or significantly abnormal studies are prioritised. In addition to being uploaded to EPR, the referring consultant for the investigation will be contacted by a member of the sleep team where this is appropriate.

Ultimate clinical responsibility for reviewing the investigation result and correlating with the child's clinical status remains with the referring clinical team. We are always happy to provide input into interpreting a result where this is helpful. Email is usually the best way to contact us in the first instance.

Due to the complexity of inpatient sleep studies, there may be a delay of four to six weeks from the study date until a report is available (for non-urgent studies or studies which are not significantly abnormal). 

Oximetry results are usually available less than a week from the date the study is returned to the Children's Sleep Centre.

Sleep study results are not directly communicated to families, as appropriate interpretation of results is only possible in the overall clinical context of the child’s care. Results are expected to then be communicated to families by the referring clinician.

Diagnostic investigations referrals

External referrals

Please see our referrals page (under 'referral for diagnostic investigations only').

Internal referrals from Evelina London clinicians

For study requests which require discussion with a sleep consultant, please contact Dr Michael Farquhar in the first instance, preferably by email. In his absence, please contact Professor Paul Gringras.

In the rare instance of both consultants being away from the hospital at the same time, requests can also be discussed with Jane Orgill, chief sleep physiologist in the Children's Sleep Centre.

Please note that studies requested as urgent must always be discussed in advance with a sleep or respiratory consultant as appropriate. Requests will be rejected if this has not been done.

The EPR forms are intended to be as quick to fill in as possible. However, a minimum amount of clinical information is required to allow appropriate allocation and management of your request and to aid in interpretation of the result. Please fill in all sections with as much relevant information as possible.

Where children are already on respiratory support this must be specified. It is essential that the child's lead consultant is consulted to decide on a plan for study conditions for the night of the study.

 

Contacts

Outpatient appointment enquiries

Tel: 020 7188 4000

Email:PaediatricAppointmentsNeurology@gstt.nhs.uk

General enquiries (not relating to outpatient appointments)

Monday and Wednesday-Friday, 9am-4pm

Sleep studies (enquiries relating to appointments for diagnostic sleep studies which have been already discussed)

Tel: 020 7188 3427

Monday-Friday, 8am-4pm

For referral contacts, please see our referrals page.
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