We got the report yesterday for both boys.  Andy is 4.5 year old and Austin is 3.3 year old.  It is so confusing to me since Andy tonsils are so huge (touching each other) and his apnea score is 0.7 and they still said it is ok.  For Austin, his tonsils are normal but since the apnea score is 2.9, they said he needs tonsillectomy (he already had his adenoids out last year).  Will this help Austin?  Will Andy be ok eventhough he has apnea?

Here is Andy's result...

Recording Time (Minutes) 455
Total Sleep Time (Minutes) 433 (Sleep Stage, N1 Sleep)
Latency to Sleep (Minutes) 12  (Sleep Stage N2 Sleep)
REM Latency (Minutes) 86  (Sleep Stage N3)
Wake Time After Sleep Onset (WASO) (Minutes) 09 (REM Sleep)
% Sleep Efficiency 95

Lights Off: 21:11 Lights On: 04:46
EEG and Sleep Stage Analysis: normal

Respiratory Analysis
# of Apn/Hyp Episodes  5  (# of Obstructive Apnea Episodes/hr)
# of Apn/Hyp Episodes/hr. 0.7  (# of Apnea Episodes/hr.)
# of Apn/Hyp Episodes/hr. NREM  0.2   (# of Hypopnea Episodes/hr.)
#ofApn/HypEpisodes/hr.REM  2.6   (Min%SaO2duringsleep(REM/NREM)
Continuous oxygen saturation, mean value %SaO2

Number of events     NREM     REM     Position        Prone     Supine
Obstructive apneas       0               0    # of events     0     1
Mixed apneas               0               0     #of events/hr.     0     0
Central apneas               0               0     Snoring                 soft
Hypopneas               1               4     Arousals /hr.         5
                                            Total # of Arousals     38

EKG Analysis: narrow complex tachycardia Vanderbilt University Medical Center Release of Information (615) 322-2062
Average Heart Rate During Sleep
Lowest Heart Rate During Recording
Lowest Heart Rate During Sleep [Highest Heart Rate During Recording | Highest Heart Rate During Sleep
 
Leg Movement Analysis: There were no periodic limb movements of sleep.

Interpretation: The findings indicate very mild obstructive sleep apnea, worse in REM and supine sleep, with associated hy] sleep architecture. This study is slightly under the pediatric criteria for obstructive sleep apnea of 1 apnea per hour of sleep w ample supine and REM sleep recorded. The patient reported better sleep than at home. No Periodic limb movements of sleep' abnormalities were noted on the limited montage nor were any ECG abnormalities noted except tachycardia. Clinical correlai



This is Austin's Result


Recording Time (Minutes) 492
Total Sleep Time (Minutes) 454   (Sleep Stage, N1 Sleep)
Latency to Sleep (Minutes) 16  (Sleep Stage N2 Sleep)
REM Latency (Minutes) 61  (Sleep Stage N3 Sleep)
Wake Time After Sleep Onset (WASO) (Minutes) 21 (REM Sleep)
% Sleep Efficiency 92

Lights Off: 20:29 Lights On: 04:41

EEG and Sleep Stage Analysis: normal

Respiratory Analysis
# of Apn/Hyp Episodes  22  (# of Obstructive Apnea Episodes/hr)
# of Apn/Hyp Episodes/hr. 2.9  (# of Apnea Episodes/hr.)
# of Apn/Hyp Episodes/hr. NREM  2.1   (# of Hypopnea Episodes/hr.)
#ofApn/HypEpisodes/hr.REM  4.7   (Min%SaO2duringsleep(REM/NREM)
Continuous oxygen saturation, mean value %SaO2


Number of events     NREM     REM     Position          Prone     Supine
Obstructive apneas        0               0     # of events     0       1
Mixed apneas                0               0     #of events/hr.     0       0
Central apneas                0               1     Snoring                  none
Hypopneas               11             10     Arousals /hr.         10
                                            Total # of Arousals     76

EKG Analysis: normal sinus rhythm
Average Heart Rate During Sleep
Lowest Heart Rate During Recording
Lowest Heart Rate During Sleep [Highest Heart Rate During Recording | Highest Heart Rate During Sleep

Leg Movement Analysis: There were 53 periodic limb movements of sleep and 7 per hour of sleep. There were 3 periodic li arousals and 0 per hour with arousals.

Interpretation: The findings indicate obstructive sleep apnea, worse in REM and supine sleep, with associated hypoxemia ar architecture with an AHI of 2.9. This study exceeds the pediatric criteria for obstructive sleep apnea of 1 apnea per hour of sle and REM sleep recorded. The patient reported worse sleep than at home. Insignificant numbers of Periodic limb movements c abnormalities were noted on the limited montage and no ECG abnormalities were noted.

I am so confused over this.  Could you guys please help me?

Thank you very much,

Anissa

One thing I'd look into is whether your son (study #2) could possibly have an iron deficiency.  That's the first thing we were told to find out about when my dd had a lot of limb movements.  

There's still not a golden standard for insurance companies to pay for treatment for children based on the pediatric scale.  We're finding that ours won't cover a cpap trial for my dd (AHI 2-4 which was felt by the pulmonologist to be underestimated/underscored) without additional proof such as a letter from the doctor and supporting data.  They start covering when it gets above an AHI of 5....  

The first study looks pretty good although if his tonsils are touching they'll likely start causing problems down the road if they're not already.  The second study is a little more concerning.  Is he showing symptoms of poor sleep during the day??  

I've got to run now but I'll look over the reports again when I get back.  Hope you're having a good day!!

Before the sleep study was done, his ped. did some blood work on him and everything came back normal.  As for sleeping during the day, he will sleep a lot 3-4 hours and when he woke up, he will say that he is tired.  A couple of nights ago, he choked in his sleep (1st time) and it was scary.  As long as he sleeps with someone on the bed (co sleep), he will sleep through the night.  If he sleeps in his own bed, he will wake up numerous times.

I'll talk to his ped again to see if his iron level was ok.

Thanks again for all of your help,

Anissa (Mama to 3 Fantastic Boys)  

I will offer this encouragement...Our son slept with us for almost a year...If we tried to convince him to sleep on his own, he'd wake up all night long and have an awful day the next day...One night, he decided (at 13 months old) that he didn't want to sleep in our bed anymore...We're convinced that he figured out he didn't need us anymore to live through the night.

Co-sleep if that is what makes everyone sleep better.  Do whatever you need to to make life easier for all parties involved.  

I'd find a sleep specialist, probably a pulmonologist based on the obstructive vs. central (neuro).  An ENT probably wouldn't hurt either.  

Our insurance covered the cpap trial as long as it had been 6 months since his last sleep study (we're only alotted one every six months...and at $4000 a pop, I don't blame them).