Hello,

I am new to the forum and overwhelmed with all of the information posted.  First, thank you for your time and efforts to help with this confusing condition.
Now,  to my situation:
My 16 y/o son was referred to an allergist by his primary care physician. We had hoped that he could be tested for allergies and possibly receive shots to help control his asthma which is fairly well under control with maintenance meds but still a worry.   Our insurance called with a recorded message with a doctor's name and number.  We scheduled what I assumed an appt. with an allergist, but found out when we were at the appt. he was actually an ENT.  Right off the bat he said tonsils would probably need to come out.  He also wanted to remove some of the tissue in his nose to allow more room for air passage.  He ordered a sleep study because my son snores & had some other symptoms of sleep apnea.  Sleep study was done, had the follow up with the doc & he said tonsils would need to come out and the nose surgery too.  What I want to know is, are there other measures we could or should try first, before the surgery? I only partially understand the data from the sleep study.  Could you please help me interpret the data so I can make an informed decision.  By the way,  my son is rarely sick except for asthma.  No strept for years now.  I don't know which info to include exactly so I'm winging it based on what info I've seen others include on the boards & what the doc circled and said was the most important info.  I only have the summary, not the actual tests.
       REM sleep was 13.5% of TST.
       Total events were 168 with an index of 29.7 per hour TST
       Minimum oxygen was 86%
       He had 1 obstructive apnea, 0 mixed, 0 central, 167 hypopneas
The hand written recommendation states "a trial of CPAP should be considered.  If CPAP fails possible surgical options could be discussed as per the patient and referring M.D."  He never mentioned any of this, just went straight to the surgery.  
My son does need a nap in the afternoon (unless something really cool is happening), makes average grades, has some memory problems (but what teen doesn't, how do you know it's abnormal?), and had or has?  ADD.  He is somewhat over weight at 5'11" & 205 lbs.
Sorry this post is so long, I just don't know what all to mention.  Thanks so much in advance for your thoughts on this.
Tina

Hi Tinahopeo:
That sleep study info is pretty sparse, really need all of it to try to hazard a guess.
Note all the things the MD circled (the ENT guy?), just curious.  And the number of desaturations.  And all the graphs.

But you're right, bottom line is, slow everything down, get all the info and then get a plan.

But just to start some chit-chat...

That's a pretty high respiratory event number (AHI), tho, and the oxygen level down to 86% is cause for some concern, so yeah, you gotta do something.

Quote:

The hand written recommendation states "a trial of CPAP should be considered. If CPAP fails possible surgical options could be discussed as per the patient and referring M.D."

I guess this was written by the interpreting physician of the sleep study, and I would at least consider that recommendation.  If the ENT won't order it have your primary MD do it.  Although given how THAT exchange went, from allergist to ENT guy, I'm going "Hmmm...", but that's the skeptical me.

Now, with that said, CPAP at 16 years old is a heckuva commitment.  For now and maybe forever.  Generally not construed to be a babe magnet.  It won't fail if it is applied properly, tho, the failure would be in getting your son to use it.  Certainly, it's in his best interests to look very closely at the tonsil/airway solution, cause he could very well be quite effectively treated by surgical intervention.  He could also have a less than 100% response to surgery, and still need CPAP afterwards anyway.

Upper airway surgery is not without it's risks, either, so that's not a decision you should make lightly (which is probably why you're here in the first place).

So anyway, I guess your choices are:  Weight loss (maybe see what that does)(although if he's 200 pounds now, wait till he gets to be my age); oral/dental device or Pillar surgery (yeah, they're out there, but that wouldn't be my first choice.  Wouldn't be any of my choices, frankly); CPAP;  surgery (good outcome); surgery plus CPAP (less than 100% outcome).

I can already hear the next question, "What's the chance of surgical success?"  That's one for the ENT guy, and/or maybe a second opinion.
sleepydave

Dear SleepyDave,

Thanks so much for your response.  I am planning on getting the full graphs, etc.  when the holiday rush slows a bit.  Yes, it was the ENT who circled the things he thought were pertinent.  Funny thing is, the handwritten recommendation was written by the ENT himself, although he never said anything about the options.  He is also listed as the Interpreting Physician.  Do you suppose with successful tx of allergies/ asthma, his tonsils could shrink, yada yada, and actually help with the sleep apnea?  Especially if he lost some weight, or grew into it height wise?  And, crazy as it sounds, the referring MD never suggested the ENT.  The INSURANCE co. made us see him before the allergist.  
Anyhow,  thanks again for your prompt response.  I will get the reports one day next week and give you more info.

Have a great holiday,
Tina

Tinahopeo wrote:

Do you suppose with successful tx of allergies/ asthma, his tonsils could shrink, yada yada, and actually help with the sleep apnea?  Especially if he lost some weight, or grew into it :-) height wise?
Tina

Hi Tinahopeo:
Tonsils shrink post-puberty, so the "grow into it" window might be shut right about now.

Treatment of allergies help?  Maybe.  Really like to look at the O2 desats closely, tho, and the rest of the info.  If you only have like one desat, and it's near or in a wake period, it might just be artifact.  If all the respiratory events simply have arousals, and maybe it's just a "UARS" type of thing, the non-CPAP options may have an excellent chance of success.

Weight loss should give some excellent possibilities.  Saying weight loss and doing weight loss are 2 different things, however.

We can talk about all these options, but in the end, the case has to be re-analyzed by PSG to determine treatment effectiveness, and you would want to see that daytime sleepiness disappear and stay disappeared.

ADD, hmmm?  You know there are a lot of children who were/are diagnosed with ADHD who may in fact had/have OSA.  Children with EDS tend to become hyperactive and inattentive as opposed to adults who just kinda nod off, hence, the confusion of symptoms.

BTW, what's he on for allergies?  Don't tell me Allegra-D.
sleepydave

Dear SleepyDave,

Lots of acronyms I have to figure out!  I'm looking forward to getting my hands on the test results.  That sounds like it will be one of the deciding factors.  For his allergies he is taking Singulair & Flonase.  He's pretty good about taking his meds, but I have to remind him.  His memory is not the best, it's kinda a joke around here, but since all of this has arisen, I wonder if it has anything to do with the sleep apnea.  He was on meds for ADD /ADHD when he was much younger.  We stopped that in 5th grade and he has done OK enough in school, but he has a student /teacher ratio 1/10 so he has lots of individual attention.  Don't know how well he'd do in the 40/1 world.  Both of his doc's questioned his grades, that's why I mentioned this.
Seems like there are so many facets to this condition and it causes so many different symptoms.  I don't want to start "blaming" apnea for everything that goes on, or "accusing" things of causing of his apnea, but it makes a lot of questions pop into my mind.  For example,  he has been telling me since about age 8 that he couldn't breath through his nose.  (that's when he started having asthma, and then shortly after, allergies.)  Once he began tx, I thought he couldn't breath through his nose (since it was now clear) because he just became used to mouth breathing.  Now, it sounds like his narrow nostril passages...
BTY-  what's the deal w/ AllegraD?
Thanks,
TinaHopeO

Hi TinaHopeO:
Allegra-D has a bunch of pseudephedrine, which can really wreak havoc with your sleep architecture (poor night's sleep, give you EDS during the next day, etc).
sleepydave

. . . because it causes lots of problems.  My daughter (almost 16) had a list of neurological, musculo-skeletal, gastrointestinal and respiratory symptoms as long as your arm and we went to specialists to try to solve each of them separately.  Turns out there is "nothing" wrong with her that some good solid sleep will not cure.  Apnea is the cause of all her distress.

When the body cannot restore itself through sleep, it starts sending up distress signals in all systems.  

Good luck getting the diagnosis and treatment your son needs.

Thanks so much for your support.  We had the appointment with the allergist today.  He told my son he was a walking allergy.  He was positive on almost all skin tests.  We will be pursuing immuno therapy and see what happens.  The allergist said Tim's tonsils didn't look that bad & didn't seem to think they would have been the cause of his apnea.  He also said he really hated to do the nose surgery on a kid.  He suggests yet another opinion from an ENT.  If one ENT says take 'em out and one says leave 'em alone, I guess will wait and see what the shots do for us.  My usually well behaved and compliant son has said he wants nothing to do with a machine.  He's invincible, ya know!

Thanks again for your support,
Tina

I read with interest your post.  My 9 year old daughter has recently been diagnosed with OSA.   She also was diagnosed at 7 as ADD.  She also has a very long list of allergies, including food allergies for which she carries an epipen.  Each physician treats their specialty and no one wants to see the big picture.  I strongly believe they are all linked - I would be curious to see the number of people with apnea that have allergies, as well as the ADD diagnosis.

My daughter had a T&A 2 months ago and she went through the surgery very well.  There is still no sign of improvement however.  The ENT said it would take about three months before we saw any change, but it is a LONG wait.

Has anyone had success with the T&A, and if so, how long did it take before you saw change?

Hey, Tuckeredout,

I look forward to hearing if you have any measure of success with the T & A.  I certainly hope you will.  I am new to sleep apnea, but I have always believed there is a connection between many of our maladies.  Keep me posted and I will post when we have our second opinion next week.

Take care,
Tina

There is quite alot of research out there now that implicates OSA as an underlying cause of ADHD symptoms.  They have proven that children with OSA do more poorly accademically than non-OSA children and exhibit the behavoural characteristics of ADHD.  Its not surprising of course.  Apparently once the OSA is resolved some improvement academically and behaviourly can be expected, but the extent of improvement seems to depend on how long the OSA has been left unresolved.

From my experience, while it is important to pursue the allergy route, don't underestimate the role long term sleep deprivation (from OSA) plays in your son's life.  OSA and even just fragmented sleep is clearly a cause for concern.  I'll let you know how we make out with the T&A.  For your information, my daughter never snored nor did she have big tonsils.  However, based on a sleep study she has OSA.  Her ENT feels that her allergies and constant nasal congestion are NOT the cause of her OSA - it is the way her throat relaxes when she sleeps.   Good luck with your next appointment.