Hi Lisa:
Central apneas are QUITE common in children, you can technically have a 20 second central apnea and be normal (although I think that is pushing it a bit) and centrals are very common in childhood REM.  For an explanation of centrals in children, take a look at

Centrals in Children

The quantity is important, too, if you only have like, 3, NBD.  As well as overall medical history, and that certainly leans toward the OSA thing.  Try to get the report and we'll take a look.
sleepydave

I am sorry you are going through this, but you have come to an amazing site. The administrators as well as the members are so helpful and have been where you are right now.

I also went through the same thing in that many(actuallymost) of my daughters apnea episodes during the sleep study were deemed as central apnea. We were sent to a neurologist. I also was actually quite freaked at the thought that there was neurological problems in what seemed like a healthy child! I was so concerned, but my pediatrician reassured me saying that there was NOTHING in my daughters history to point to neurological problems or other severe disorders. The neurologist checked her out and had nothing.

So we went back to the ENT. Evidently the apnea episodes which were most likely obstructive, masked themselves as central. Please read through all the posts. Sleepydave has been a fount of information and he knows his stuff. He is also reassuring and calming when necessary!

If you are still worried after the T&A, then talk to your ENT and see if he can order another sleep study and see if the central episodes are still there.....

Please keep in touch, these people are awesome!  
Erika

Thanks so much - sleepydave and Erika.  I really appreciate the response from both of you.  

I have the report and there were, in fact, 61 central apneas with the longest being 12.8 seconds...31 obstructive apneas, the longest one of those being 17 seconds...7 obstructive hypopneas, longest 12.8 seconds... and one mixed, for 10 seconds.
Baseline oxygen sats were 94.3% (he was getting over a respiratory infection) with 83% during NREM and 85% during REM that occurred with the obstructive and central events.

It makes me feel much better to know that this IS normal to some extent, although 61 seems like a lot to me.  What do you think?  Thanks again.
    
                       Lisa

Hi Lisa:
And a total of 100 events in a child is a real lot.

As Erika says, central events in children can also be really obstructive in nature, they simply weren't picked up by the sensors properly.

So after we weed out all the definitely "normal" centrals (post-arousal, normal REM, etc.), we have to analyze those that are not.  However, if you have desaturations with them, they are no longer in the normal category.  And O2 desaturations of <90% in a child will definitely perk your ears up.

OK, so now you take the total number of events that are or may be obstructive in nature and divide it by the total hours of sleep, and you get an average number of apneas and hypopneas per hour, or index (AHI).  Should be in the report someplace.  They may include all events, but if these centrals all have desats, let's leave them in there for now.

Front line treatment for OSA in children is T&A.  Using the obstructive AHI as a guide to recommend surgery, some folks will go to surgery at AHI 1.0.  We recommend surgery at 3.0.  Pretty much everybody will recommend surgery at 5.0.

By my calculations, your son's obstructive event AHI alone (not counting any of the centrals) is already 5.1.  If you include all the centrals, then it's 13.3.

The ENT is absolutely the next stop on your journey.
sleepydave

The report has the REM AHI at 13.3 just like you said.  Wow, that's bad.  

We go back to UVA Tuesday to see the ENT for the first time.  He's going to have to decide what he can do because along with all of this, my son has a bifid uvula (and therefore possibly a cleft of some sort? - which they say may rule out doing adenoids) and a palatal torus.  His pediatrician has recommended doing a CAT scan before surgery to take a look at what's going on anatomically in there.  

You have no idea how wonderful it is to have found this site and be able to correspond with you about this -- it has been so frustrating to not have any good/reliable resources for info on this.  You're great.  Thanks again.
      Lisa

Hi Lisa:
AHI for NREM, REM and Total Sleep Time measure different things.  We want to look at Total Sleep Time, but a REM AHI that hefty is significant, so you get the idea.

BTW, why do you happen to mention Chiari?
sleepydave

Hey SleepyDave,

Actually, I think they have the AHI at 13.9 for total sleep time.  

Chiari was brought up when the sleep specialist called to discuss the results of the sleep study with me.  When she was explaining about the central apnea, I asked what types of things can cause it.  She mentioned that as being one possible cause, although very unlikely in his case.  She said that she had seen one case out of hundreds of central apnea cases that was actually caused by that syndrome...and it was in a 12 year old boy who had 460 some episodes in one night.  She also said that he would most likely have other neurological issues going on -- as well as chronic pain and irratibility...which he has never had.  He has always been a very happy, easy going, and bright little boy.

That's what has bothered me so much in looking into this...that there does not seem to be much information on what conditions actually cause this type of apnea.  Most things I've read have been geared toward OSA.  

Why?  What do you know about Chiari?

Lisa

Hi lisa:
Yeah, we did have a poster with a child with chiari, jester.
I went back and saw the thread just kind of ended, but we had a little trouble getting the graphs up.
Anyway, from a purely statistical point of view, centrals in children are ususally disguised obstructives or normal phenomenon.
As you can see from the examples, you can usually determine the significance of the central event.  Do you have the architecture graph?  That could shed some light.
Best thing to do is sit tight and see what the ENT guys say.
You can (and perhaps should) get retested after whatever treatment course you have chosen is completed.
Yeah, there are some scary things out there associated with central apnea, but when you hear hoofbeats, don't think zebras.
sleepydave

See Lisa! He is so great! Good luck with this. Please keep us posted on what the ENT says and what will happen.

SleepyDave, we have stopped the enurises 3 nights in a row....I have started her back on her SIngulair for her allergies. Could this be the culptrit? Allergies?

He is great.  Really seems to know his stuff.  Very refreshing at this point.    Good luck to you too!  And I'll let you know what I find out on Tuesday.  
Take care,
    Lisa