Hey all!  I have some questions RE: my 13 month old son who was d(x) with obstructive sleep apnea.  Early November, he had an adenoidectomy and bronchoscope perfomed.  No issues with the adenoids.  During the bronchoscope, his lungs were full of mucous which they suctioned out and he had sores in his windpipe and lungs.  Tests showed lipase and digestive enzymes.  He was ultimately d(x) with aspiration pneumonia and put on extended dose of abx.  We are scheduled for another sleep study December 15th with PH probe and CPAP titration, if necessary.

My questions:
1- Do you think the apnea can be caused by the reflux?
2- Do you think the PH Probe is necessary?  I mean, we know he has reflux.  What will this show?
3- He is still up many times during the night.  No real change post-surgery.  I was rocking him back to sleep last night and he was still snoring like a grown man and I could count during his pauses in breath.  Does it sound like he may still have the issue and may require the CPAP?  I am trying to manage my expectations and not be surprised by results this time.

Thanks so much in advance!  Also, if there are questions you think I am missing that I should be asking, please, please let me know.  Thank you!

shawnb wrote:

Hey all!  I have some questions RE: my 13 month old son who was d(x) with obstructive sleep apnea.  Early November, he had an adenoidectomy and bronchoscope perfomed.  No issues with the adenoids.  During the bronchoscope, his lungs were full of mucous which they suctioned out and he had sores in his windpipe and lungs.  Tests showed lipase and digestive enzymes.  He was ultimately d(x) with aspiration pneumonia and put on extended dose of abx.  We are scheduled for another sleep study December 15th with PH probe and CPAP titration, if necessary.

My questions:
1- Do you think the apnea can be caused by the reflux?
2- Do you think the PH Probe is necessary?  I mean, we know he has reflux.  What will this show?
3- He is still up many times during the night.  No real change post-surgery.  I was rocking him back to sleep last night and he was still snoring like a grown man and I could count during his pauses in breath.  Does it sound like he may still have the issue and may require the CPAP?  I am trying to manage my expectations and not be surprised by results this time.

Thanks so much in advance!  Also, if there are questions you think I am missing that I should be asking, please, please let me know.  Thank you!

I am not Dave, but I have been thru the PH Probe test.  Its not the most comfortable test, but it will show the severity of the reflux, the duration, and if it was after eating, or when laying down.  Lucky for him he is way to young to remember it, I unfortunately still remember mine, but it was a necessary evil as it was definitive in measuring the strength of the acid and the duration of the events.

Hi Shawnb:
Wow, that's a lot to deal with.

Did he get his tonsils out?  Any other surgical options?

The GERD-apnea relationship?  Yeah, possible the GERD may make apnea worse, but it's unlikely it's the exclusive cause.  Was the airway swollen during the bronchoscopy?  Is it better now?

You know, you can still have GERD and aspiration when you're awake, as Mike notes, perhaps monitoring pH will make that point more clear.

I think you're still going to have to work with the numbers we had before.  If the AHI is up, if the desaturations are still there, if GERD treatment doesn't change that, and if there are no surgical options available, then CPAP is the next on the list.

Sounds like you're gonna get all the info (how about the ETCO2 measurements?) to make the right decision.
sleepydave

Thanks for the replies/thoughts.  We met with the GI last week and the sleep specialist this morning.  They both agree that the PH probe is necessary, but differ as to whether they feel Harry should stay on his meds (prevacid).  The GI says pull it for 72 hours and the sleep specialist says keep him on them throughout to make sure they are working because if they are not working, we may need to discuss Nissen surgery.      Thoughts on whether we should continue or discontinue reflux meds during study?

So, Dave, I guess there is another surgical option - tonsillectomy and/or Nissen?  But, what the hell is happening?  I feel like I need these two people to agree, not disagree...

He did not have his tonsils out during the other procedure because they appeared to be normal size, not large.  Our ENT did not think that the benefit from removing them would outweight the risks of removing them in a 12 month old.  Especially in light of the lung issue and what was going on there.

Mike and Dave, you are both right on.  After our GI appt. where we discussed what was found in Harry's lungs, the GI has some concerns regarding Harry's swallow and wants to make sure we don't have a swallowing issue contributing to the aspiration.  Swallow study is tomorrow afternoon.

Dave, I am definitely going to get all the information this time and request the ETCO2 numbers.  I will also verify the criteria for grading an apnea episode (10 seconds or two breaths) After the next study, I will post his results.  We'll get those 12/23.  Wouldn't it just be GREAT if it turned out his apnea is gone!  Am I dreaming or is that possible?

THANK YOU AGAIN!  YOU HAVE NO IDEA HOW MUCH THIS HELPS!

Hi Shawnb:

Quote:

The GI says pull it for 72 hours and the sleep specialist says keep him on them throughout to make sure they are working because if they are not working, we may need to discuss Nissen surgery.  Thoughts on whether we should continue or discontinue reflux meds during study?

Always go with the sleep specialist!

Ok, seriously...

There's all different possibilities, but it strikes me that if the Prevacid is working, and it turns out that Harry has significant OSA, you gotta go after the OSA.

If the Prevacid isn't working, the situation may be a little cloudier, you have to see if the GERD figures in as a contributor to the OSA.

If you stop the Prevacid, then you... what's the point of stopping Prevacid?  I mean, to me, it seems like the effectiveness of the Prevacid will be reviewed by the sleep study.  If it's working well, then wouldn't you stop there?

I think no matter which way you go you're going to end up with multiple tests.  Let's hope the swallowing test goes OK.

Quote:

Wouldn't it just be GREAT if it turned out his apnea is gone! Am I dreaming or is that possible?

Boy, I would wish that too, but if you're witnessing apneas, and with that snoring, that might be a lot to hope for.
sleepydave

Alright, I have thought this over for a week now and I am going to go with the sleep specialist and continue the prevacid.  The bottom line for me is that we know he has reflux, we know he is aspirating and now, I want to know if the dose is effective and if not, whether or not his reflux is contributing to his apneas.  I am concerned that we may miss something because the acid will be reduced due to the PPI and therefore it calls into question whether the probe can actually do its job, but ...  I'm going to go with my gut.

I may be wrong here but aren't GERD and Reflux two different things.  My 10 year old son had severe reflux as an infant, needing surgery, but test after test showed that he did NOT have GERD.  Fortunatly his reflux was just that--reflux.  No apnea.  Other problems but not that.  The PH test was a bonus because we found out that is reflux was the type that he lay down.  We were able to save him some of the pain while waiting for the surgery.  He still has to take Prevasid.  The reflux is better, but still there.  With the snoring I think and pauses, I think it is wise to take him to the sleep specialist.


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