Desperate Mum to son with UARS seeking advice

[Illorum]

I personally don't think RERA scoring will make much of a difference since his arousal indices were normal, which was why I suggested CAP analysis.

At least now you have access to physicians who actually listen and Guy's has people that do CAP analysis.

Furthermore Geer1, PAP therapy isn't the only treatment for SDB. BunnyMummy's son has retrognathia and narrow jaws according to previous posts. Maxillomandibular advancement and/or EASE or SARPE could probably cure him for life, which is why proper diagnostics is important - he's at a good age for those procedures.

Another good diagnostic other than CAP analysis would be the percentage of his breaths that are flow limited while asleep on a sleep study. 95% of people with >30% flow limited breaths will have UARS/OSAS symptoms.

[BunnyMummy]

Illorum what do you mean by the arousal indices being normal?

Do you think I should be requesting Cap analysis then? It's difficult, I already P*ssed the other sleep consultant off by asking too many questions, I don't want to get off on the wrong foot with the new guy. But I don't want to waste time doing a standard psg if he then needs something else.

Thank you for all your help

[Illorum]

Yes, I think CAP scoring would be important for your son for multiple reasons:

1) His arousal index was 10, which is exactly the average amount of arousals someone his age should have. Assuming this is correct, he would have little if any RERAs. That being said, there are some people who have naturally very low arousal indices, but that's less common.

2) He had a large amount of periodic limb movements, 28/hr, though they were not associated with arousals. In the comments of the PSG it said that many of the PLMS were preceded by "episodes of shallow breathing" (flow limitations). This is a clue that they're related to CAP, as flow limitations can induce PLMS that include a CAP A phase change.

PLMS is tightly related to CAP: https://pubmed.ncbi.nlm.nih.gov/8858493/

With all that noted, the technician did note in the comments that the EEG signal was poor and that results should be viewed with caution, so it could be that the arousal index is way off. It would have been nice if they'd scored the flow limitation index instead of just leaving it blank...

I personally think it would be a good idea to request CAP analysis. For a case as tricky as his I think it would be important to apply the best diagnostic tools available, especially if he's going to be getting another study anyway. It is not a particularly burdensome task, there is software that does it automatically.