We recently had a sleep study done on our son because he hasn't been sleeping well, usually waking up around 4:30-6:00 AM. Doctor's have commented that he has very large tonsils and we were expecting to find OSA. However, we got back a result of CSA which was very scary. This is made even more so because he is a pretty medically complex child. He was a 24 week preemie and had a bi-lateral grade IV intra-ventricular hemmorage which left him with hydrocephalus and cerebral palsy. He also has siezures and is on meds to control them. The biggest fear is that the 4th ventricle in his brain may be trapped (not transferring CSF to the other 3 ventricles). This ventricle resides close to the brain stem and if it is pressing on it will cause CSA. To fix it requires a 4.5 hour brain surgery which we don't want to have to do unless absolutely necessarry. Anyway, here are the results and we are wondering if anybody could shed a little light on the results and if they are something we should just monitor or be worried about. We have an appointment with a pulmonologist to discuss the results but they can't fit us in for a while. Many thanks in advance.

Sleep = 423 min
Apneas = 6 central, 0 obstructive, 0 mixed
Hypo Apnea = 1 obstructive, 0 central
Apnea Duration = less than 10 seconds
Minimum Sats = 1 event down to 88% and 1 event down to 84% (this is the thing that scares us the most, 84% seems pretty low)
AHI= 0.9929 (1)
2.7 events/hr in REM sleep
0.3 events/hr sleeping supine
1.6 events/hr sleeping on side
1 arousal associated with apnea/hypo apnea
49 spontaneous arousals
7.1 arousal index
End tidal CO2 - normal

Welcome! How old is your son now? Is the wake up time the only sleep disturbance you'd noticed prior to the sleep study, or did you have other sleep related concerns as well?

It's hard for me to speak to your son's results with a lot of clarity simply because, as you say, he is medically complex child, and it requires the expertise of professionals who are able to take into consideration all of his challenges in order to see the whole picture. Strictly from a sleep apnea perspective, however, I wold say that things look pretty good (to the degree that that can be said of sleep apnea at all -- which is debatable when its your own child...) As you accurately noted, the desaturations down to 88 and 84% are the most concerning aspects of the results, however, since the information you provided (and perhaps were provided yourself) don't indicate the amount of time spent at those 02 sat levels, it's hard to even say how concerning that is. It's preferable to see 02 sats above 90%, but drops into the mid 80's are not uncommon -- but again, it is very significant how long the duration of those desaturations. The normal End Tidal CO2 is a positive sign, as is the limited number of apnea episodes. If your son had no other health issues at play, I would guess that a monitor and see approach would be advised, possibly with a recommendation for CPAP use. However, I think you are going to have to really work closely with ALL of your son's medical care providers to determine the best course of action, because there is a lot at stake and a lot of issues to consider. I'm assuming your son has a neurologist already, and I would strongly encourage you to make sure that you are able to communicate with BOTH the pulmonologist and neurologist (ideally at the same time) about the sleep study results and the possible implications and recommendations.

Also, I encourage you to get a copy of the COMPLETE results from the pulmo -- as those will have more information, including the amount of time spent at various O2 saturation levels, and his sleep architecture, among others, which can be VERY significant when it comes to looking at the study of a child with pre-existing neurological conditions. For example, we were told that our son's last sleep study results looked great because he had no apnea episodes. However, when I looked at the complete results, it turned out that he had not even ONE SECOND of REM sleep in over six hours of sleep time, and during his first study he'd had 8 episodes in the approximately six minutes he spent in REM sleep (out of over 5 hours of sleep time). Until I brought it up, no one even noticed the lack of REM sleep and the significance that might have given that, typically, most apnea episodes occur in REM sleep. It turns out that some neurological conditions can affect the seep architecture sufficiently to call into question the accuracy of sleep study results. It can get pretty confusing, and it is very important to recognize that no single specialist is likely to be able to fully and accurately understand your son's situation. It may fall to you to bring all the experts together in order to see the whole picture clearly.

Best wishes to you, and do keep us posted....