7 year old newly diagnosed with sleep apnea

[ColoradoMom]

Let me preface my comment by pointing out that I'm fairly new to this myself and I don't have the same level of expertise of those who have already weighed in. 
My son also has sleep apnea, although he is older than your son. I found it difficult to find information on pediatric sleep apnea. A previous poster referenced this, but I wanted to reiterate that classifications for sleep apnea are different for pediatric patients; an AHI of 1-5 is mild, 5-10 is moderate, and >10 is severe.
I have found this forum to be incredibly helpful. Another great resource I found that helped me gain a much better understanding of sleep apnea is a podcast by Dr. Stephen Park (he is an ENT doctor who specializes in sleep disordered breathing). He has a couple of podcast episodes that are focused on pediatrics, if you google him you'll find a link to the podcast on his website. 

I don't have much incite to offer on the twitching, but I notice that you listed that the sleep study noted that leg movements were associated with respiratory arousals. Did you spend the night in the room when your son had his study? If so was his twitching the night of the study typical of previous nights that have raised concerns? 

Good luck!

[Sleep2Snore]

He looks to have more central than obstructive apneas.
However, as Sleeprider points out, we have only seen a summery of the results without how long the apneas lasted etc.
I see his oxygen levels are still quite high so that is at least a good thing.
There are a few things that can cause Sleep Apnea in children, shape of the jaw, throat, large tongue and of course if he is over weight this will not help.
If he has a large neck this will also not help much and it is something he can't do much about.

However, all you can do is go with the medical advice and it is always good to seek another opinion if you are not convinced by the doctor.

Anyway, if they do push you towards a CPAP machine, make sure you get an APAP (Automatic machine) like a ResMed Airsense10Autoset unless they decide he needs a more sophisticated machine, if I were you I would still insist on a ResMed.  You can also monitor his treatment with the ResMed machines using Sleepyhead.  It will take you a while to get used to reading it, but help is here if you require it.

Good luck with your son and do keep coming back to let us know what the doctors are thinking and doing.

It is not so uncommon as you think for children to have Sleep Apnea.
Thankfully, it is not very common, but I know of quite a few here in the UK.

[Hojo]

I would agree with the Obstructive Apnea being given as a wrong label and it is most likely a computer generated or simply a generic label that the doctor dictated.  I too had been told I had Obstructive Apnea even though I didn't have a single episode, all were central apnea events so I would continue to investigate for a possible cause.

[mopr]

@Sleeprider - Yes, it makes no sense how the diagnosis is OSA when the obstructive events are so few compared to the central apneas. We have an appt in a couple of weeks where I hope to get more information from the dr. For now, he has said 'some central apneas are fine - the so-called post-arousal centrals'. I have no idea if the central apneas are post-arousal. I wish they would give me the raw data!

Thanks again for your insights - helps me be more prepared and educated.
The ENT has said no surgery is needed for him. I think our next step is going to get the dental braces to expand the jaw. We were going to do that in summer anyways and we can only hope that it helps.

The first thing that pops up is how central apneas are related to underlying neurological issues - which is definitely keeping me up at night.

[mopr]

@Coloradomom - thanks! I will send you a pm, if you don't mind. Most kids sleep apneas seem to be related to obstructive reasons. At the sleep study, I couldn't tell if he had the twitches because they had me sleeping in a separate bed to not corrupt their data. And it was dark. I am asking for the videos to check and haven't had any luck getting them yet.

@Sleep2snore - thanks for weighing in. He is actually a small kid and at around 12% tile for weight, with a small neck and head. He is very active and hasn't had any academic trouble so far. The jaw seems to be the only thing I can latch onto for now, physically since the dentist had mentioned it. The ENT didn't seem to think there was any trouble with the jaw, after a cursory look.

A couple of questions for the experts -

I wonder - is there a device, sort of like a mouthguard that we can try out for a couple of nights to see if that would help with this issue? The palatal expansion of the jaw will probably take a year or so.
Also, are there any particular pillows that are more helpful?

Mohana

[Mogy]

Hi Mohana,
I disagree with much of what is being speculated on about Central Sleep Apnea.
His CA index is 1. There is no reason to start speculating about CSA. My CSA was 0.7 on my sleep test.  Most people have some Central events when transactioning between sleep and awake. If he was having a hard time staying asleep it would be easy to get those few Central events.
The 80 hypopneas are what is making up the majority of his AHI. Hypopneas can be either Obstructive or Central in nature. There is no way for any of us here to determine whether they were Obstructive or Central.
I had very few Obstructive events on my sleep study, a few centrals, and a lot of hypopneas. Very much like your son. I have OSA. There is a 98 to 99% chance that your son has OSA like the doctor diagnosed.
There is a very very small chance that he has Central sleep apnea. At this point I think we are doing you a disservice to be discussing it.

[Sleeprider]

I wonder - is there a device, sort of like a mouthguard that we can try out for a couple of nights to see if that would help with this issue? The palatal expansion of the jaw will probably take a year or so.
Also, are there any particular pillows that are more helpful?

Mohana

Mouth pieces, or mandibular advancement devices can help with some cases of obstructive apnea, but there are complications including Temporomandibular dysfunction and pain.  I would be cautious with a child.  Something that works very well and has no complications I'm aware of is a soft cervical collar.  This would just be tall enough to keep the neck aligned and apply light pressure to the back of the jaw as he sleeps.  Many of our adult members have resolved positional obstructive apnea using an adult version, and they can be comfortable.  I would think a collar height less than two inches, with a roomy fit so the chin does not drop under the collar might prove comfortable and effective.

With regard to the sleep study records, a complete copy is your right under the Federal HIPAA law. https://www.hhs.gov/hipaa/for-profession...index.html  Those records may be important in the future, and you should make a point of requesting them and keeping them if you ever need it.

[mopr]

Mouth pieces, or mandibular advancement devices can help with some cases of obstructive apnea, but there are complications including Temporomandibular dysfunction and pain.  I would be cautious with a child.  Something that works very well and has no complications I'm aware of is a soft cervical collar.  This would just be tall enough to keep the neck aligned and apply light pressure to the back of the jaw as he sleeps.  Many of our adult members have resolved positional obstructive apnea using an adult version, and they can be comfortable.  I would think a collar height less than two inches, with a roomy fit so the chin does not drop under the collar might prove comfortable and effective.

With regard to the sleep study records, a complete copy is your right under the Federal HIPAA law. https://www.hhs.gov/hipaa/for-profession...index.html  Those records may be important in the future, and you should make a point of requesting them and keeping them if you ever need it.

Thanks SleepRider! I am going to get a cervical collar today and try it out. And thank you for the warnings on the mouth pieces and the specifics of the collar. 

Mo

[Mosquitobait]

I wonder - is there a device, sort of like a mouthguard that we can try out for a couple of nights to see if that would help with this issue? The palatal expansion of the jaw will probably take a year or so.
Also, are there any particular pillows that are more helpful?

Mohana

Don't go with the mouthgard option.  It's hard enough on adults (can cause TMJ, treatment for which is not covered by insurance).  For children forming bone and new teeth, it can cause permanent problems.  That's why jaw and teeth stuff are done by orthodontists.

[DeepBreathing]

Hi Mohana,
I disagree with much of what is being speculated on about Central Sleep Apnea.
His CA index is 1. There is no reason to start speculating about CSA. My CSA was 0.7 on my sleep test.  Most people have some Central events when transactioning between sleep and awake. If he was having a hard time staying asleep it would be easy to get those few Central events.
The 80 hypopneas are what is making up the majority of his AHI. Hypopneas can be either Obstructive or Central in nature. There is no way for any of us here to determine whether they were Obstructive or Central.
I had very few Obstructive events on my sleep study, a few centrals, and a lot of hypopneas. Very much like your son. I have OSA. There is a 98 to 99% chance that your son has OSA like the doctor diagnosed.
There is a very very small chance that he has Central sleep apnea. At this point I think we are doing you a disservice to be discussing it.

You're quite right that we don't really know the make-up of the hypopneas. However given that central and mixed apneas outnumbered obstructive apneas by a factor of 7.5:1 it's at least possible that the hypopneas (or the bulk of them) are central in nature. Hopefully they're obstructive, which simplifies everything. But to not mention the possibility (I think it's a probability) would be doing a worse disservice to this young man and his parents.

Although central apnea is not common, it's by no means as rare as some would have us believe, as testified by patients on this forum. It's also the case that central apnea is often / usually misdiagnosed and patients have to go through endless cycles of sleep tests, try and fail with many different machines and months or years of suffering before they get the right treatment. By considering the possibility up front (and forcing the doctor to consider the possibility) we might be able to ensure the appropriate treatment is delivered as soon as possible.