Hi.  I have an 11 yo son who was recently diagnosed with sleep apnea.  He developed bronchopulmonary dysplasia at birth and was oxygen dependent until age 2 and steroid dependent until age 5.  At about that time, he was diagnosed with ADHD and also with Tourette's Syndrome.  He typically doesn't present with any sleepiness which the pulmonologist says is typical in children, rather lots of hyperactivity that hasn't seemed to be controlled by medication over the years.

I think I only got a summary but I'll include all the information I can.

Type of Study:  Nocturnal Polysomnogram

Sleep Summary:
Total Time Recorded:  420 minutes
Total Sleep Time:  407 minutes
Sleep Efficiency:  97%
Sleep Latency:  0.5 minutes
Sleep Onset/Latency to REM:  357 minutes

Sleep Architecture:
Patient spent 2% of the time in stage 1, 51.9% in stage 2, 17.5% in stage 3, 26.5% in stage 4 and 2.1% of the time in REM sleep.

Respiratory Event Summary:
Significant obstructive sleep apnea with an apnea/hypopnea index of 4.  REM sleep-related apnea/hypopnea index was elevated at 28 per hour.  There were a total of 30 obstructive respiratory disturbances.  Of these respiratory disturbances, 60% were associated with arousals.  Mean duration of respiratory disturbances was 10 seconds.  Snoring was soft.

Oxygen Saturation Summary:  Baseline oxygen saturation was 99% with a mean of 98% and a low of 82%, with 0.7% of the time spent below a saturation of 92% and 0.1% of the time spent below a saturation of 85%.

Periodic Leg Movement Summary:
No periodic leg movements were noted.

Cardiac Summary:  No significant cardiac arrhythmias noted.

Impression:
Significant, predominantly REM-sleep related, obstructive sleep apnea in an 11yo boy.  Of note, a normal apnea/hypopnea index in a patient this age is less than 1 per hour.


The recommendation was for tonsillectomy, adenoidectomy and turbinate reduction with a sleep study to follow up in two months after surgery.

We went to the ENT today and he recommended no surgery based on his exam and called the pulmonologist to begin CPAP immediately (he felt that the risks of surgery outweighed the benefits and that a CPAP would be necessary after any surgery anyway).

I've seen some of these episodes with no breathing, no initial response to attempts to arouse, followed by a huge intake of breath, like he was under water and in desperate need of air.  It's been scary to watch.

I'm sure I need the complete report to get much info from you but I'd appreciate anything you can help with!  Thanks, Julie

Hi Julie:
With that tiny bit of REM sleep (normal is about 20% of the night) and delayed REM onset (should be about 90 minutes) I'll hazard a guess that's he's also on a REM-suppresant medication.
Even if that's not the case, what this means is that if he were to start getting a normal amount of REM sleep, the respiratory events would increase 10-fold.
So, yeah, he definitely needs something.
Surgery is often very effective in children with OSA, but you've obviously got a bunch of other factors to contend with.  Upper airway surgery is not without risks, many of which are very significant.
CPAP should be effective tho, but the approach should be done patiently and spending extra time with mask fitting and getting used to the device.
The summary you've provided is good, I think you hit all the high points.  Maybe if they measured carbon dioxde levels, ETCO2, that might be helpful.
Stay in touch.
sleepydave

thx for your input, sleepydave!  we are seeing the pulmonologist (with all your info on this board, i found out he is board-certified!) on monday and will have the titration sleep study hopefully this week.