Hello!  My son is 1 today and we recently had a sleep study.  Our sleep specialist said he will likely need surgery.  I am hesitant.  We are seeing an ENT Friday and I am trying to understand everything before I go in and potentially sign up for surgery.  Also, is there testing that should be done to look at my son's passages or do they just recommend surgery based on this information alone?
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WT: 21 lbs  Ht: 30 in  BMI: 16.4

Sleep Data:
Time in Bed: 518 min.
Total Sleep Time: 423 min.
REM Laatency: 47.5 min
Sleep Latency: 0 min
Sleep Efficiency: 81.7%
No. of Awakenings: 11

Sleep Time in Stages:
(1) 2.0%
(2) 38.8%
(3) 17.3%
(4) 20.6%
(REM) 21.3%

Abnormal Respiratory Events:
Total: 110
Apnea + Hypopnea Index: 3.2 events/hr
Respiratory Disturbance Index: 15.6 events/hr
Mean Duration of Apnea/Hypopneas: 11.3 seconds
Longest Obstructive Event: 17.6 seconds
Overall Mean Oxygen Saturation: 96.9%
Mean Oxygen Saturation During Obstructive Events: 92%
Lowest Oxygen Saturation During Obstructive Events: 81.6%

Types of Abnormal Respiratory Events:
Obstructive Apneas: 1 (.9%)
Obstructive Hypopneas: 15 (13.6%)
Respiratory Effort Arousals: 85 (77.3%)
Central Apneas: 0
Mixed Apneas: 0

SAO2 profile:
419.6 minutes @95-100%
1.4 minutes @90-95%
Electromyographic Findings:  No abnormalities were noted.

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Some of this I understand.  Still, what I am unclear about is whether this warrants surgery.  Thank you.  I appreciate the help!



Last edited by shawnb on Mon Dec 26, 2005 6:56 pm; edited 1 time in total

Unless they suspect some significant cause for the respiratory arousals, your sons level of obstructive apnea, in my humble opinion, doesn't warrent surgery. At least try your non-surgical options first. I would get a second professional opinion. My understanding is that most surgeries are only about 50% effective for sleep apnea.

I am not a professional and my experience is limited so take my opinion for what it is worth but his sleep efficiency is decent and he has the normal amount of REM. His O2 is fine also. I would trade his study for mine any day.

Although there is no consensus on what constitutes abnormal values in childhood OSA, the values are considerably lower than that associated with adults.
Generally, anything over AHI 1.0 is considered abnormal.
Our categories are mild AHI 1.0-5.0, moderate at 5.0-10.0, and severe >10.0.
Desaturations in children are uncommon.  Or put differently, the presence of desaturations raises concern.  A desaturation to 81.6% in a 1 year old definitely perks the ears up.
Children usually sleep through all events, so you usually don't see a phenomenon like RERAs, but with significant snoring I suppose it's possible...
...however, something just hit me, and looking at the average event length, ask what criteria they use to score apneas and hypopneas.  You should be using missing 2 breaths, and not, for instance, the 10 second minimum that you use in adults.  That will significantly change the numbers.  Don't forget the ETCO2 totals, too.
Some folks advocate surgery with obstructive AHI of > 1.0, we use 3.0, some folks will go to 5.0.
Unlike adults, surgical intervention in children has a high success rate.
BTW, Happy Birthday, little guy!
sleepydave

Thanks so much for the thoughtful replies.  It is certainly something to think about...

sleepydave, thank you again!  You are amazing!  I am a bit worried now about my son's results.  I am wondering if maybe they did score them using the 10 second cutoff?  I will call them tomorrow and find out.  That would explain the high number of RERAs, but I am guessing that maybe it wouldn't make our results better in terms of having fewer apneas.  Or, am I misunderstanding it.  Would some of the RERAs being meaningless or would they then become hypopneas/apneas and count in the AHI?  I didn't get the ETCO2 totals yet.  Waiting on those from the doctor.  When I get him, I will definitely ask about the RERAs.  You are honestly the best.  Thank you so much.  I feel so much more informed already and that empowers me in making the right decision for my son.  And, thanks for the birthday wishes.  He had a marvy birthday!  Too bad I don't know how to post a picture or I'd post one of him eating his cupcake and bore the hell out of everyone!  

Edited for spelling.  It is so bad...

Well, we had a follow up sleep study with PH Probe and it looks like things are better in some ways, but also not better (I don't want to say worse) in others.  I don't know what to think.  Any insights?
Right now, the sleep specialist is recommending we get Harry's reflux under control and then repeat the test to see if the reflux could be impacting his airway causing swelling resulting in the many RERAs.  I have no idea what to do at this point beyond an aggressive approach to his GERD.  If this was your child, what would you do?  

WT: 24 lbs Ht: 32 1/4 in
Sleep Data:
Time in Bed: 482.5min.
Total Sleep Time: 416.5min.
REM Laatency: 71.5 min
Sleep Latency: 15.5 min
Sleep Efficiency: 86.3%
No. of Awakenings: 20

Sleep Time in Stages:
(1) 1.6%
(2) 37.2%
(3) 24%
(4) 18.4%
(REM) 18.8%

Abnormal Respiratory Events:
Total: 148
Apnea + Hypopnea Index: 0.7 events/hr
Respiratory Disturbance Index: 21.3 events/hr
Mean Duration of Apnea/Hypopneas: 9.2 seconds
Longest Obstructive Event: 9.8 seconds
Overall Mean Oxygen Saturation: 95.5%
Mean Oxygen Saturation During Obstructive Events: 91.4%
Lowest Oxygen Saturation During Obstructive Events: 89%

Types of Abnormal Respiratory Events:
Obstructive Apneas: 2 (1%)
Obstructive Hypopneas: 0 (0%)
Respiratory Effort Arousals: 143(97%)
Central Apneas: 3 (2%)
Mixed Apneas: 0

Electromyographic Findings: No abnormalities were noted.
Other findings:  No snoring was noted durin ghte study, but the patient was noted to gasp for air and laugh while asleep.  One decrease in PH was noted to last for 1.5 minutes and dropped to 2.3%.  It was not associated with an apnea.

Hi ShawnB:
Where you able to determine what their criteria for respiratory event scoring was?
How about those ETCO2 levels?
And if there wasn't any snoring, how were they able to score all those RERAs?  Were they using an oro-nasal pressure transducer?  Really need to determine if those RERAs are really hypopneas-- how were they able to score them as RERAs?
sleepydave

Hey Sleepydave!  Happy holidays!  I hope all is well!  Is it snowy in CT?  Thanks, as always, for all your help...

I had the same tech as before and she was not very cooperative.  First, she told me she was not testing for ETCO2 because she requires a script from both doctors (the GI and sleep specialist) to do it.  And, all she would tell me about the scoring is that they use the standard practices in the industry and that was it.  When I pushed, she was not very nice and asked me to leave her be so she could do her job.  I'm sure she is excellent at what she does, but again she made me feel like this is my "fault" -for lack of a better word.  I have no idea why all the RERAs.  I have no idea why.  I am feeling quite desperate.  I am not sure what an oral-nasal pressure transducer is.  Can you help me there?  He did have a monitor stuck up into his nose (not the probe.  It looks like one of those things that people have when they are on oxygen.).  Is that the transducer you are referring to?  Basically, at the end of my sleep study results consultation, the sleep specialist gave me the feeling he is washing his hands of us.  He said that I need to get aggressive with the reflux and since I am moving, find good doctors in our new hometown and good luck.  Great.  Thanks for the help!

Hi ShawnB:
My response to the "we use the standard practices in the industry" would have been, "So then where's the ETCO2 monitoring?"  OK, nothing to do about that now.

If the airflow device looked like an oxygen cannula, then it was probably a pressure transducer.  A pressure tranducer is more sensitive that other airflow devices, and could have identified more of the RERAs as hypopneas/apneas and made decision easier.

I'd still try pushing the interpreting physician for the scoring criteria.  Hey, they may use the 2 breath criteria, but if not, then EVERYTHNG is different.  And even if they do, then ask what is their scoring criteria for a RERA.  It has to be SOMETHING.  And if there was no snoring, then what the heck were they using?  If it was something like flow limitation, then maybe that RDI becomes significant.  If it wasn't, and it was due to GERD (and that's a lot of arousals) why would they call them RERAs?  They'd be GERDAs.
sleepydave

Great minds think alike... that's pretty similar to what I asked her and she responded basically with, "Where's the script?"  I think they cut an awful lot of corners.  So, what I don't understand is if this pressure transducer is more sensitive and Harry had one, why are they still RERAs and not apneas/hypopneas?  

Do you know any good specialists in denver?  We are moving there in late January/early February.  Maybe they can help me help my son.  

Who determines the industry-wide standard/best practices?  Maybe I can go back to them with that info and try to get some answers...  I will definitely ask what the scoring criteria is for an RERA.  Definitely.  I'll let you know when I hear back from them what they say.

Maybe I should come there and have you do his next sleep study...

shawnb wrote:

Great minds think alike... that's pretty similar to what I asked her and she responded basically with, "Where's the script?"  I think they cut an awful lot of corners.  So, what I don't understand is if this pressure transducer is more sensitive and Harry had one, why are they still RERAs and not apneas/hypopneas?  

Do you know any good specialists in denver?  We are moving there in late January/early February.  Maybe they can help me help my son.  

Who determines the industry-wide standard/best practices?  Maybe I can go back to them with that info and try to get some answers...  I will definitely ask what the scoring criteria is for an RERA.  Definitely.  I'll let you know when I hear back from them what they say.

Maybe I should come there and have you do his next sleep study...

Hey there....

National Jewish  is here in Denver (where I had my sleep study) and has a pediatric clinic I beleive...you might try calling there. They have a really good rep around here.

Welcome!