hello, my 4 year old son has apnea on nightly basis. We took him to the ENT and found that his tonsils look fine but the adnoids are enlarged.

when I notice him sleeping the time apnea happens, about 10+ times an hour no longer than 5-12 seconds, his throat and chest are pulling in but no air is coming. that tells me that his body is trying but there is an ubstruction. It sounds like the air way is cleared when his tongue is moved or his lower jaw. almost like a vaccum that can't hold it's suction and then finally it gives and he can breath breifly.

He has been a thumb sucker since birth and still sucks his thumb only at night and only 1/3 of the time he is sleeping.

I noticed that when he is sucking his thumb he has no signs of apnea other than a slight nasil restriction due to his enlarged adnoids (only guessing here).
My question is what would cause his apnea when he is NOT sucking his thumb? possibly a narrow palete.

we have the opportunity to get his tonsils and/or adnoids removed...should we? I dont know.

any input guys?

thank you
Scott

Hi Scott,

My guess as to why your son does not seem to have apnea while he is sucking his thumb might be because the suction on the thumb is just enough to "pull" the obstruction open enough to get air through the nose. Does that make sense? From what I understand, CPAP (pressured air) kind of does the same thing, just in reverse....the pressured air acts as a splint that pushes the obstruction open (that's the best way I know how to describe it.) But, this is just my guess.

I know with my own son, he had more or less apneas depending on his sleeping positions (same principle applies here, too - the right angle would "open" the obstruction to some degree.) But, the right position only helped for a little while, then we noticed that he could not breathe through his nose at all at night no matter what position he was in, eventually it got to the point where he was breathing through his mouth even during the day.

Your description of his apneas are very accurate. If his chest is caving in, instead of puffing out on an inhale like it should, that is called paradoxing....definately a sign he is fighting against an obstruction. The way you described the "vacumm releasing it's suction and then he can catch his breath again"....sounds like an arousal. When we fall asleep the tissue in the back of our throats (tonsils, adenoids) becomes relaxed and floppy and can block airflow, then the body fights against the obstruction....the brain will eventually say, "ok body, we've got to wake up a bit to tighten that tissue in the throat so we can get some air moving in here." It's very subtle, the person usually isn't aware of the wake up call from the brain, but it's just enough to disturb our sleep...over and over and over again...all night long. And the pattern is very tough on children.  

It's hard to say, what exactly causes the apneas in alot of cases (especially children, I think) but the majority of doctors start with removing adenoids and tonsils as a first line of treatment. If that doesn't work, then they usually try cpap therapy.  

I noticed you mentioned that an ENT said his tonsils looked fine but his adenoids were enlarged. Has your son had a sleep study done? Did the doctor suggest a sleep study? A sleep study might provide you with some clues to the cause of his apnea, too, which will help you decide wether to have a tonsil/adenoidectomy or not.    


One of the best things I did to help get my son treatment was to videotape him sleeping. We caught a couple apneas on the camcorder, took it in with us to the ENT, and the doctor looked at it and -for the first time with any of the many doctors we had seen-we were taken seriously.  

I hope this helps, let us know how it is going. Welcome to the forum.

Kim

Thank you so much Kim for the reply. I recently have video taped him sleeping and have footage of his apnea in hopes of them doing a sleep study. I haven't asked the Dr. for a sleep study yet because I'm still not sure what to do at this point.

You said it well with the position of sleep, it's gotten to the point that it's routine in my sleep to wake of 4-5 times a night to check on him and his apnea. I do think adenoid removal is needed for his nose and the ENT said he would let us know during the surgery if the tonsils needed to come out.

I just want to make the right decision before putting him through that.

He has autism and is hyper-sensitive to anything placed on his face. It's a nightmare to give him breathing treatments for his asthma.

again thank you for your time and knowledge, I certainly will keep you posted

Scott  

My 4yo was just diagnosed yesterday with sleep apnea.  The ENT says the sleep study said that he stops breathing approx 5.1 times per hour.  It actualy is probably more than that but, when they did the study, he was propped with 6 pillows.  At home he will sleep with 1 maybe none.  The ENt did and x ray and said that she was surprised that his tonsils and adenoids were not enlarged.  She said that she could tell that he was a mouth breather.  He has asthma and allergies.  She gave us a sample of Singulair to try.  Usually he is on Pulmmicort 2 times a day and Xopenex4- 6 times a day.  I have to email her in a week an a half to tell her my opinion of the medicine.  She doesn't want to do a T&A if  she can get away with it.  She just did 2 of them on my daughters last month. I would never recommend doing 2 on the same day. Thanks.

Thank you for the reply. My son too has allergies and asthma, we give him a daily breathing treatment of Pulmmicort and as needed we have albuterol. This poor guy never seems to catch a break in such an early life, has is overcoming Autism and eye/vision issues.

just curious but now long where the delays in breath for your child during the sleep test?

During his adenoid removal I'm really going to press that unless his tonsils are enlarged to the point of hinder I will not let them touch them.

thanks everyone  

He had a reaction to the singulair.  He went from a typical boy to the "devil reincarnate"  Hitting,punching, biting, headbutting ect.  The ENT said it was a side effect. She told me to immediately take him off of it.  We can do a T&A but it may not solve it.  She would then consider putting him on CPAP.  if the t&A doesn't work.  She recommended Nasonex if we want to try another med option before surgery. He has a reaction to Oraperd when he takes it for bronchitis. I don't know what to do.   Here are his results, but we were told to not take them for face value,that  he was in a sitting position propped up by pillows, not lying flat like usual at home.  
Time in bed 466.5 min
Total sleep time 400.5 min
Sleep efficiency 85.9%
Sleep latency 9.0 min
REM latency 112.5 min
Stage 1 3.4%
Stage 2 39%
Stages 3 and 4 43.1%
Rem 14.6%
Baseline SaO2 Awake 97%
Baseline SaO2 REM 97%
Baseline SaO2 NREM 97%
Lowest SaO2 recorded 94%
Periodic limb movement index 0.6 per hour
Periodic limb movement index with arousal 0.1 per hour
Total Arousal Index 8.8 per hour
Mean heart rate 85 bpm
Baseline EtCO2 Asleep 45mmHg
Highest EtCO2 Recorded 52mmHg
Apnea/Hypopnea Index 2.4 per hour
Total respiratory events 16
Central Apneas 1
MIxed Apneas 0
Obstructive Apneas 0
Hypopneas 15
The nadir occured in association with a 27 second econd obstructive hypopnea occurring with the patient sleeping supine during REM sleep.

sounds like they found some really good information. Everything seems to make sense if his A&T are small yet he is still having apnea. the high hypoapnia, and I'm no doctor, seems that he would benefit most from the cpap.

wonder why they didn't let him lay down like at home for a more accurate reading.

wow that's some side affect from the singulair, wonder how they worded that on the box for a cation label.  

did your doctor say why she would recommend a A&T removal before the cpap?

Under less common side effects it had agitation including aggressive behavior.  I guess that is better than Hepatitis.

Hi jgoebel,

I'm a bit confused.  Your sleep study info is from the baseline study (without cpap), right?
If so, the AHI of 2.4 is normal, not sleep apnea.  Apnea is defined as an AHI over 5.  There is an arousal index of 8.8, but I'm not sure if all arousals are respiratory-related.    Am I missing something?  How do they say this is sleep apnea?


Linda


_________________
Click here for link to FAQ and topics
Click here for link to section on machines and masks

I think it was because he was basically sitting up during the testing.  he was not lying down during testing.  I have to email the ENT back on Monday.

I believe another parent (writing about an older child) reported being told by her daughter's doctor that, for children, an AHI over 1 was considered to need treatment.

Best wishes,
Bill

why did they have him propt up during the test? That doesn't make sense, it would-as it did-make the results useless.

Hi everyone, just wanted to post an update with my son's apnea.

last Monday he had his adenoids removed to which the Doc said they were larger than expected. After some time to heal to my relief my son is breathing so much better at night. I check on him throughout the night and i'm grateful that it is working so far.

thanks everyone