7 year old newly diagnosed with sleep apnea

[mopr]

Hi! 
     I just joined in the hopes of getting some information to help with my 7 year old who has been recently diagnosed with sleep apnea but no enlarged tonsils or adenoids sadly. 

We went down the road of sleep study because he was having myoclonic jerks as soon as he falls asleep for 30 min - 1hr. And for an hour - 2 hours in the morning just before wake up. And a few times in between as well but not as much as immediately after falling asleep or before wake up. We were thinking periodic limb movement or something like that. But the sleep study results say he has sleep apnea! Not expected at all since we don't hear him snoring or see his breathing change when he has the limb and body jerks. 

Checked out with the ENT in the hopes that it was tonsils or adenoids and turns out that unfortunately, thats not the case. 

I am hoping someone here can help me get educated on what these things mean in the results and also to see if anybody has any experience seeing these symptoms for sleep apnea. 

Any help/insight is much appreciated!

RESPIRATORY ANALYSIS:  (index = #/hr)
Apnea/Hypopnea Index (AHI): 11.3
*AHI 4% or greater: 2.0
NREM AHI: 9.9
REM AHI: 15.3
Non-Supine AHI: 10.9
Supine AHI: 11.9

Respiratory Disturbance Index (RDI): 13.5 
NREM RDI: 12.9
REM RDI: 15.3

Apneas (index, #): 2.0  (17)  
Obstructive Apneas (index, #): 0.2  (2)  
Mixed Apneas (index, #): 0.7  (6)  
Central Apneas (index, #): 1.0  (9)  
Hypopneas (index, #): 9.3  (80)  
RERAs (index, #): 2.2  (19)  

Mean Awake SpO2: 99%
Mean Sleep SpO2: 98%
Minimum Sleep SpO2: 95%
Sleep Time with SpO2 < 88% (min, % of TST): 0.0  (0.0%)

Cheyne Stokes breathing: No
Snoring: light  

Thanks in advance,
Mo

[Walla Walla]

I haven't had any exposure to what your going through with your child. Just want to offer encouragement about the treatment. Having to use the machine really isn't that bad. Kids seem to adapt to these kind of things much better than adults do. I do know they set the AHI requirement a lot lower for children than adults. I believe it's an AHI of 1 or more where an adult is 5 AHI or more. We have some sharp people here so hopefully someone can give you more insight. Good luck with everything.

[PaulaO2]

Have they checked his throat for deformities or narrowing?

He's having a lot of hypopnea. That's where the airway narrows but doesn't close all the way (which is an obstructive event).

The jerking is common.

What does the sleep doctor propose as treatment? Other than look at his tonsils and adenoids, what else did the ENT say?

[DeepBreathing]

G'day mopr. Welcome to Apnea Board.

I think there are very few (if any) of us here who have detailed knowledge of apnea in children, but we will try to provide what information and help we can.

Looking at your son's results I think his apnea / hypopnea is central in nature, not obstructive. Please forgive me if I'm repeating something you already know...

Obstructive sleep apnea occurs when the tissues of your upper airway collapse during sleep and physically obstruct the air flow. There is an excellent little animation at the bottom of this page: http://www.apneaboard.com/wiki/index.php...=Wiki_Home

Central sleep apnea is a very different thing. It occurs when the brain fails to send a "breathe now" signal to the lungs. This may be because of a neurological condition or brought on by substances such as opioid painkillers. It can also occur in people who are new to CPAP therapy because of an imbalance of CO2 in the bloodstream.

Mixed apnea is (as the name suggests) a combination of obstructive and central apnea

Hypopnea is a reduction in airflow, but not a complete cessation. Hypopnea can be obstructive or central in nature.

In adults the treatment of choice for central apnea is an adaptive servo ventilator (ASV). This looks the same as a CPAP machine but has more sophisticated internal systems which monitor the airflow and adjust pressure on the fly to keep the breathing nice and regular. I use one myself and the results are extremely good. (I used to have the myoclonic jerks previously but they have completely disappeared, along with heart palpitations).

Whether an ASV would be prescribed for a child I don't know. This is something you'll need to discuss with your doctor. There may be a reluctance to put such a young child on this type of therapy, but the apneas and jerks won't be doing him any good.

If he does go onto a machine you will need to come up with a strategy to get him to accept the mask as part of his nightly routine. How you do this will depend entirely on his level of maturity and overall personality. Maybe get some pictures of a fighter pilot or scuba diver for his wall? As WW said above, kids are resilient and adaptive, so hopefully it won't be too much of an issue.

Good luck and best wishes for your son. Please come back with any other questions and we'll help you as much as possible.

[SarcasticDave94]

Hi mopr, and welcome to Apnea Board.

I can only backup what others have stated, just including my sincere best wishes on getting your child the successful medical care needed via a PAP device. FWIW there are some cool looking animal masks available for kids that may help him adapt more readily to treatment. Me? I would get one but they're too small.

If you have to take the ASV route, I sincerely believe the ResMed AirCurve 10 ASV to be the best there is available. I have it, and it's truly a literal life saver. Again best wishes on success. Post back if there's questions or whatever. Take care.

[mopr]

Thanks everybody for the responses! Totally and sincerely appreciate you all taking the time to share your insights.

PaulaO2 - the ENT mentioned at the very end that my son has a thin webbing like palette which could be causing issues. Just as a maybe. I do remember that the dentist had told us last time that his jaw is small and there isn't place for the new teeth to grow properly. 2 adult teeth have replaced 3 baby teeth! And that he will need braces to expand the jaw. Not sure if that would have any relation here.

DeepBreathing - I have absolutely no knowledge of the different apneas so your detailed response is much appreciated. Sounds like central apneas in kids are very rare I may have to go back to the neurologist, it sounds like. Not at all what I was hoping for ...
I had not heard of the ASV so far so thats good information, thanks!

Hi Dave, thanks for the recommendation on the machine you are using. I will make a note of that for the next appt with the sleep clinic.

[SarcasticDave94]

You're very welcome. Keep us updated. And have a great day despite this situation. Face it with knowledge and beat it into submission. Best wishes for your family.

[Sleeprider]

mopr, the sleep test you posted suggests the majority of events your son experienced were central apena, not obstructive. At the same time, h is oxygen saturation during sleep is excellent and perhaps the relatively low rate of apnea and hypopnea are not serious enough to consider intervention. Since the problem is clearly not obstructive, do not be persuaded to commit to procedures to open his airway as this will not help and has potential for unnecessary complications.

I think this is a case that should be monitored, but but not treated at this time. Your pediatrician and neurologist should be consulted to help you with your concerns for your child's health. The presence of mild central apnea in children is not widely researched, and I'm certain that neither CPAP treatment nor Adaptive Servo Ventilation (asv) are desirable in a pediatric patient in good health and with these kinds of sleep study results. The news is actually pretty good here, and the priority should be to watch for any changes in your child's alertness, fatigue levels and functioning, and avoid committing to anything that could be worse than these symptoms. Especially, he should not be put on CPAP therapy or endure ENT surgical procedures as a result of this finding. CPAP has the potential to make central apnea worse, and is itself disruptive to sleep for treatment of such a minor case based on AHI and oxygen results. Surgery is completely uncalled for.

[mopr]

Thanks Sleeprider for the hopeful words. As I am researching more, I realized that the diagnosis given by the doctor in the report is actually Obstructive sleep apnea even though the central sleep apneas were larger than obstructive ones.


CLINICAL INTERPRETATION:

1. Findings are consistent with Obstructive Sleep Apnea in a child.
The apnea/hypopnea index (AHI) was 11 events per hour of sleep and RDI was 13.5 events per hour of sleep.
Note that in children, AHI >1 and/or RDI >5 is consistent with sleep apnea.
From an awake baseline of 99%, during sleep, the lowest oxygen saturation was 95%, and 0 % of the sleep time was spent at saturations below 90 %.
Snoring was present.
2. No Cheyne Stokes respiration.
3. No EEG or EKG changes or abnormal behaviors were noted.
4. Periodic leg movements of sleep were not significant. All leg movements were associated with respiratory related arousals.

I am still waiting to hear back from the doctor to help understand what is going on here. I am not even sure how sleep apnea could explain the continuous twitching we see at certain times. I expect sleep apnea would be one jolt to get the brain to wake up and start breathing and back to sleep. Please correct me if I am over simplifying the process.

[Sleeprider]

mopr, I disagree the findings are consistent with obstructive sleep apnea, and that diagnosis is practically boilerplate and devoid of analysis. Of course we only have a summary, and it would be very advantageous to have the full detailed study including PSG graphs. These are something you should request for your records in the event you want a second opinion.

If a CPAP is prescribed, be sure that there will be a clinical, medically supervised titration study before the machine is dispensed, and that efficacy is demonstrated at the prescribed pressure. This is not a place where experimentation or a casual diagnostic is tolerable. CPAP or any proposed therapy must demonstrate an improvement to a target efficacy over the baseline condition. Every case of apnea on this forum is originally diagnosed as "obstructive sleep apnea", but about 15% of those diagnoses are eventually changed due to complex or central apnea. I can think of a small handful of cases where central or complex apnea is properly diagnosed by a sleep doctor based on obvious polysomnography (PSG). This is simply endemic in the profession due to insurance requirements to fail CPAP before an appropriate central apnea therapy is prescribed.

Your child may or may not improve on CPAP, if that is deemed appropriate. Make them prove that it works in a clinical test. Do not take their assumption or this diagnosis as final.