Hello everyone!  I am new to this forum and am very excited that have found it.  My son is turning 8 years old next month and here is the brief history of his problems.

At age 3 he stopped bedwetting for 2 weeks and I was sure we are all done with the potty-training and night bedwetting.  However he got pneumonia and the bedwetting came back.  He hasn't been dry at night since...  He has occasional drippings during the day as well, however after going through various medical exams (urology, MRI, etc.) the doctors didn't find any problems.

He's always been sleeping with his mouth open, very deep sleeper (impossible to wake up), needs 11 hours of sleep, had cases of night terrors and snoring (on and off).  After doing some research, I realized he may have sleep apnea.  In addition to the symptoms above, he is a pretty moody child, even though bright, isn't doing as well academically as he could be.  Sleep study was done last September and after that was completed, the doctors diagnosed him with OSA.  Even though his tonsils and adenoids are normal size, 3 doctors are recommending T&A (2 ENTs and the sleep study specialist).  They aren't guaranteeing that this will help with sleep apnea or enuresis, but are saying the chances are good.  They also mentioned his narrow throat size and jaw structure could be contributing to OSA, but they aren't sure.

I don't have the details of the sleep study with me.  The main things doctors mentioned was that his breathing stopped for an average of 20 seconds.  Not all of those cases were obstructive.  He did get good % of oxygen through the night.

I am really not sure what to do - we scheduled the surgery for 24th of March, however even though all doctors we've seen are recommending T&A, I just feel uneasy about it.  I am not sure if I should be considering this surgery as necessary or optional.  Should we wait?  Could he outgrow the problem?  What are the downsides of T&A?

Here is additional information - the letter from sleep specialist with the results:

Sleep Staging:  Total recording time was 487 minutes, total sleep period 456 minutes, total sleep time 403 minutes, and sleep deficiency reduced at 83%.  Sleep onset latency was slightly increased at 32 minutes.  Stage I was 10% of TST, stage II 47% of TST, stage III 22.6% of TST, and REM 20% of TST.

Movements:  The patient had no documented periodic limb movements.  He did have 38 spontaneous arousals for an index of 5.7.

Respiration:  The patient's respiratory rate averaged between 18 to 24 breaths per minute.  He slept 20% of the time in the supine position.  Light snoring and frequent mouth breathing were observed.  The patient had 5 obstructive apneas with a mean duration of 11 seconds and 36 obstructive hypopneas with a mean duration of 12 and longest duration of 20 seconds.  Additionally, he had 8 central apneas with a mean duration of 8.5 seconds.  The apnea-hypopnea index excluding central apneas was elevated at 6.7.  The patient had 7 snore episodes, all of which were associated with arousals.  The mean oxygen saturation was 97%, and the minimum oxygen saturation was 93%.

Impression:  It is my impression that this sleep study does document obstructive sleep apnea as indicated by the elevated apnea-hypopnea index.  In addition, the patient also appeared to be mouth-breathing throughout most of the study which tends to be associated with increased work of breathing and increased upper airway resistance.

Hey, i think its actually nothing to worry about, its very good you caught it so early so you'll have plenty of time and options to consider.

The tonsil and adenoid removal are extremely routine, commonly performed on not sleep-apnea patients, thus the risk is also very low.  I had my tonsils removed around the same age, for different reasons. I didnt find out about my apnea until i was 26. It most definatly affects Everything.

It'd usually be the first thing they try as its very tolerated by the patient and has the potential for making a difference. Once that area is cleared up, they can re-evaluate the situation to see any change. As obstructive sleep apnea is anatomical, its a unique case for every person, it often is a melange of factors which all contribute. tongue falling back, throat collapse, jaw resess etc..

If it turns out he needs more surgery its important to really educate yourself on the options. As any surgery like that is with risks. Usually relatively low and most definatly worth it. but again, dont worry about that until you need to. address these things as they arise, no use in playing the mental chess game of what if..

check out www.sleepsurgery.com  the doctors Powell and Riley at stanford, wrote the book on sleep apnea surgery and have performed and developed most of them.  there's some good info on the surgeries in there.


good luck!
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Hi alinai:
When I get the trade journals, I usually rip out the articles I want to save and pitch the magazine.  As luck would have it, this is an article I found yesterday that gives a great, easy to read summary about OSA and T&A, and fortunately, also appears on the web:

Pediatric OSA

Yeah, I know, maybe not the swing vote you're looking for.

Your post shows that you have pretty much covered all the bases and have a great understanding of what's going on.  Looks like every professional opinion you've sought is on the same page.

On the one hand, yeah, the chance to improve a couple of important facets of your son's life.  On the other, a less than 100% chance of success (usually thought to be about 80%, probably somewhat less in your son's case if there's other structural factors underfoot).  And upper airway surgery, with anesthesia, is not without it's risks, some of which can be significant.

I'll tell you what bothers me though.  Your underlying concern about the procedure seems more than the routine anxiety of a mother sending her child to surgery.  There's something to be said about intuition, and I of all people am not going to say, "Yeah, go to surgery, no big deal" when there's something that is really bothering you but you can't quite put your finger on it yet.

That's a decision that can ultimately be made only by a child's mother.
(Yeah, I'm a dad, and I know where my place in the home is.)

That said, there are some technical study considerations you might follow up on.  Were end tidal carbon dioxide measurements used?  This is darn near essential when monitoring pediatric patients.  You need to look at the high level, in mmHg, and the time spent over 50 mmHg.
What type of airflow sensor was used?  Was it a pressure transducer, thermistor, RIP, something else?  That can effect the AHI.
There is always discussion about what a hypopnea is, even in children.  Did these folks use an airflow reduction of 50-80%, an arousal AND a desaturation, or just an arousal alone?  While children don't necessarily have a lot of desaturations, some guys have considered desaturations of only 2.5% to be significant in kids, vs the 4% we use in adults.  How many desaturations were there, too.
And what was the total number of arousals, just curious to see how the numbers add up.
Stay in touch.
sleepydave

Sleepydave, thank you very much for the article link and additional questions re: sleep study.  I will be calling the sleep center specialist today to ask these questions.  You are right on the money though re: mother's intuition.  No matter how many times I heard that T&A is routine & is nothing to worry about, it still didn't feel right to me.  Now after doing further research and thinking it through, my husband and I have decided to go ahead with T&A for our son.  Thanks again!

Davidxje, thank you for the reassurance and the website reference.  It is certainly helpful to hear more and more about success stories of T&A to make me feel better about going ahead with it.