I have been noticing for about 6 months now that my 3 and half yr old daughter stops breathing in her sleep, quite frequently. She does not snore, but every stop is preceeded by a sort of a big sigh and then nothing for about 8 secs. She also moves around in bed a lot and makes 360 circles around the bed with her body while sleeping.

I mentioned this to her doctor twice now and he said that unless it's over 20 secs, it's nothing.

Should I insist on a sleep test?

If she is diagnosed, what are the treatment options for kids?

She has also been dignosed with pallid infantile syncope (white breath holding, passes out in times of sudden scare) and I think she suffers from reflux (not diganosed).

Please help, what should be my next step?

Hello Lala:
There is a resource here that will help you to decide if she has Obstructive Sleep Apnea:
http://www.sleepapnea.org/resources/pubs/children-osa.html
Also keep in mind that there are plenty of other sleep disorders that can be uncovered by a pediatric sleep study.  Including the nocturnal effects of GERD, make sure the lab you choose does esophageal pH probes, if you end up going that route.
An apnea that follows a big sigh may be a TYPE of central apnea that is benign, read this thread about central apneas:
http://www.apneasupport.org/viewtopic.php?t=334
If a central apnea in a child includes an oxygen drop or a significant heart rate change, though, it is of concern.  Need a sleep study to do that.
People have different criteria for measuring the duration of apnea in children, but it's always less than the 10 seconds we allow for adults.  We use missing two successive breaths, which is in the neighborhood of say 6 seconds.

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I mentioned this to her doctor twice now and he said that unless it's over 20 secs, it's nothing.

Let me qualify this.  You can use the 20 second rule if if you have an uncomplicated central sleep apnea.  But you can't tell that without a sleep study.

You've got a lot of sleep disturbance there, and a sleep study could very well uncover an issue(s) that will help you.
I'd go to a Board-Certified sleep specialist though, sleep medicine in children is different from sleep medicine in adults.  Make sure they are associated with a laboratory that can do children as well.

Stay in touch.
sleepydave

Hi sleepydave,

Thanks very much for replying. I read through the articles and am a little bit overwhelmend with terminology. I am a complete novice here.

I am puzzeld by this "approximately 40 percent of children referred for suspected OSA have negative sleep studies. We therefore strongly recommend polysomnography in all children with suspected OSA".

So there are abviously differents sleep tests out there. Which one should I go for? Remember so far her doctor didn't want to suggest any tests, so I'd have to ask for something.

...And this "and can result in significant morbidity and mortality." Obviously very alarmed by this and I am sure no one can elaborate more on it, but what causes mortality and how often does it occur?

Her doctor did say that I should watch it for a bit and count the number of seconds between breaths (to establish if it's long enough for concern) and listen out for her heart beat. So, on averabe it is about 7-8 seconds between breaths, almost always preceeded by a sigh (then nothing, she breathes in not out). I listened to her heart, it apprears to be normal, ie not rapid, except on occasion it seems that is slows down a little bit and skips a beat. And her sleep positions are certainly strage. Do the normal children have strange sleep positions? She is generally turns upside down, ie legs on the pillow, during the night and I often have to reposition her, through the nights. She sleeps with us for now until I decide what her sleep patterns are. I forgot to mention that she also excesively grinds her teeth in her sleep and I've noticed that sometimes her eyes open and close but she is asleep.

I am not sure which way you are leaning in this case OSA or CA? I couldn't decide from the articles. I certainly hope that it 's not CA as there doesn't seem to be any cure. In fact the only cure, if it exists at all is T&A and everythig else seems to be just helping breathe through the night.

What are the kind of sleep disorders that can be caused by GERD?
Is there any connection between SA and white breath holding during waking hrs?

An finally, do children grow out of SAs and what's the % that do?

Thanks again, and sorry for too many questions.

Hello Lala:
I hope I can answer all your questions, let me know if I miss something or don't explain it clearly.

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"approximately 40 percent of children referred for suspected OSA have negative sleep studies. We therefore strongly recommend polysomnography in all children with suspected OSA".

You don't know for sure if you have OSA based on history alone, so you have to test to be sure.

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So there are abviously differents sleep tests out there.

Nope, just one, polysomnography, but you can get different options.  You need all the routine channels, plus end tidal carbon dioxide measurements and the esophageal pH monitor if you want to check for nocturnal GERD.

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And this "and can result in significant morbidity and mortality."

I wouldn't worry about this yet, nor the type of treatment.  As of yet, there is no diagnosis.

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What are the kind of sleep disorders that can be caused by GERD?

OSA and GERD can theoretically contribute to the other.  Negative pressure in OSA can draw gastric contents into the esophagus, and the gastric contents can cause the upper airway to swell and worsen the obstructions.  GERD can cause sleep disturbances alone.  BTW, there may be another cause to your child's sleep disruption, causing arousals and the sighs.  Again, get a PSG.

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do children grow out of SAs and what's the % that do

Probably, as tonsils get smaller at puberty and the airway gets relatively larger.  There's no way to really track this though, if you knew a child has OSA and allowed them to continue untreated for 6, 8, 10 years to see if the OSA would abate-- well there's no way you could ethically allow a study like that to occur.

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I certainly hope that it's not CA as there doesn't seem to be any cure.

No, there's a lot of CA in children that is harmless, normal, and I showed you several types in the tracings.  That your doctor says track pulse rate during the apnea tells me he's certainly on the right track, but watching oxygen levels is probably more important.  And that's done in a sleep study.
I know you're using all your powers of observation, but I just don't think you can differentiate between central and obstructive.  The event could precede the sigh, cause the sigh, and yeah, you've got a central event that is benign but the important event snuck right by you.  Again, objectively measured in a sleep study.
And you don't need a lot of obstructive events either.  The number of obstructive apneas that are clinically significant is MUCH lower than adults.  Like anything more than an average of ONE per hour is considered abnormal.
All of these questions will be answered definitively by the sleep study.  It sounds like you still have concerns about the care of your child, and the study, if normal, will give you peace of mind.
I agree with the article about 40% of children sent to the lab turn out to be normal.  Shoot, I'll even say that it's 60-40 that your child will be perfectly normal, and I honestly hope that's the case.
But at least then you have peace of mind, that not only the concern for apnea is now relieved, but any of the other possible sleep disturbances that might be causing these issues.
Stay in touch.  BTW here's another more detailed reference that you might find helpful in your decision process, and I think is a pretty good explanation.
http://www.emedicine.com/ped/topic2114.htm
sleepydave[/quote]

Hi-

     2 years ago my wife noticed my son having problems sleeping and gasping for air. He was 2 1/2 yrs old.  He subsequently had his tonsils and adenoids removed and his problems went away and he has slept well since.  I will keep an eye on him and my daughter for the future though - since I was recently diagnosed with severe sleep apnea and am going thru the wringer trying to deal with it.   Good Luck to you.   - John