Night of Kentucky blues: the case of the hypoxic child in the sleep laboratory

Sleep-disordered breathing is an increasingly identified condition in the pediatric population, resulting in an increasing number of direct-to-lab referrals for polysomnography (PSG). We present a unique case of a pediatric patient who demonstrated continuous hypoxemia during PSG. A 6-year-old Black female presented for PSG via direct referral with obstructive sleep apnea as a concern. At the onset of the PSG, oxygen saturation of 85% while awake and at rest was noted. The oxygen saturation did not improve despite troubleshooting, probe and patient repositioning, or probe replacement. The PSG demonstrated an average sleep oxygen saturation of 81%, with oxygen saturation nadir of 73% and apnea-hypopnea index = 6.1 events/h, consistent with mild obstructive sleep apnea with persistent desaturation. Hemoglobin electrophoresis was consistent with hemoglobin Louisville. This case illustrates that communication between the sleep medicine physician and the community physician after a direct to lab referral is crucial to avoid concern and confusion.