Pediatric OSAS diagnosis Help

[CafeConPan]

Hi everyone, 
My 9 year old daughter was recently diagnosed with OSAS. We have done a sleep study and awaiting to see a ENT specialist but that won’t be until 8/20/21.

I’m here in hopes to get some advice and any tips to make her feel comfortable until we get seen. 

Tonsil removal is our last resort and I am already looking into our insurance to see what machines are covered and all that. 

Her sleep study report indicted the following: 

Sleep efficiency of 94.2% 
AHÍ of 3.8 episodes per hr
Supine AHI of 4.7
REM-AHI 0.0
Oxygen desaturation was documented to a nadir of 82% in association to respiratory events.



Respiratory data:
Patient had 0 obstructive apenas 
6 central apenas
21 obstructive hypopneas
Average apnea-hypopnea index of 3.8 per hr. 


I am completely new to this and just recently joined this group today. 

I left Our follow up appointment yesterday with her regular pediatrician ( sleep study was referred out) with 0 questions answered.

Is her apnea case  pretty bad,mild? 
Any advice, links to other websites to get more educated is appreciated.

Thank you,
Worried momma

[SarcasticDave94]

Welcome to the Apnea Board,

If you've not done so yet, call the doc's office and request the sleep study report, the detailed one is better. HIPAA law permits you to request and receive it. You'll want it for personal health records and if you wouldn't mind, post a redacted version here in a post. We can get a better grasp on the Apnea via that actual test data.

On the info you've posted, 0 Central Apnea is a good sign as that should eliminate a more complex PAP called ASV that treats Central Apnea. Not many Obstructive Apnea, but a significant amount of Hypopnea. Hypopnea are 50-80% restriction vs Apnea which are 80-100% restricted. Either of these must have a time duration of 10 or more seconds, or they aren't defined as Apnea or Hypopnea.

The supine AHI means how many events average while sleeping on one's back. 4.7 is just below the cutoff of 5 for mild Apnea. This is close obviously, and you might make a case to get doc to script an APAP. But it's a maybe.

I think if we include the desaturation info of dropping to 82%, then it increases the likelihood a PAP is needed. That desat number worries me a bit, and can be clarified on how bad it really is by knowing how long oxygen was that low. That detailed report has that, so solidifying a need for you to have a copy.

Here's something to consider, rearrange your daughter's bed to include extra long pillows, where she'd sleep against them to help prevent back sleeping. This is a temporary, for the time being, action. Next would be to get a CPAP and mask, I suggest a ResMed AirSense 10 AutoSet, maybe the For Her AutoSet.

Suggested actions:
Call the doctor's office and request the sleep study detailed report.
Call insurance and ask about CPAP coverage and for several DME's that are in-network with your plan.
Call these DME's and ask what brand of CPAP machines they sell. Do they sell ResMed AutoSet For Her? You'll need a match on selling ResMed and in-network, and one you trust.
Last one, get OSCAR, a free report tool some forum members created. It's safe to use. It'll tell you a whole lot more about PAP usage than what the doc will suggest. We at AB can coach you into fully controlling her PAP therapy, if PAP becomes necessary.

PS At any DME, do not give bank or credit card info. It's not ever required to process PAP approval.

[sheepless]

just a few general comments.

unless there are other issues, your daughter's ahi isn't high enough to prescribe cpap to a adult, but I don't know if it's different for children.

the duration of the O2 desats are as important or more important than the nadir. others here can tell you with greater accuracy but my understanding is that in adults, O2 must dip to a certain low % for some time, like at least 5 minutes to be considered significant. again, idk if different for children.

it's really good that you're addressing this now. if me, I'd press for cpap/apap, even if they tell you it's unnecessary - for the long term benefit and to enable you to monitor her condition over time (the data the machine produces can be seen in great detail in the OSCAR program, free on this site). I can only imagine the extent to which my life would have been more productive, active, fun if anyone had picked up on my sleep issues and if there had been treatment available when I was a child 60 years ago. I'm sure my sleep issues and apnea were mild back then but believe me it gets worse in time. it saddens me to realize in retrospect just how profoundly sleep deprivation affected me over the decades.

the vast majority of us in the U.S. are diagnosed with obstructive sleep apnea regardless of the sleep study results. doctors' tend to ignore or downplay central apnea. your daughter had 6 central apnea events compared to zero obstructive apnea and 21 obstructive hypopnea. that doesn't scream mixed apnea or cry out for a central apnea diagnosis exactly but keep an eye on it if you can, to gain some insight as to the frequency, character and significance of her central apnea. you'll be able to do this if she's prescribed a pap machine. otherwise you just have monitor her. audio and especially a video recorder would make this easier. also be aware that if she starts using a pap machine, her central apnea may increase. this may be a common response to new use of a pap machine (called treatment emergent) that will abate in 30-90 days or it may exacerbate any pre-existing tendency she may have toward central apnea.

[Gideon]

The standards are much more strict in children.  The medical protocol for children is to evaluate for Adenotonsillectomy.

Here are the standards.

Here are the AHI levels of severity for Sleep Apnea in Adults:
Mild: 5-14
Moderate 15-29
Severe: 30+

Here are the AHI levels of severity for Sleep Apnea in Children:
Mild: 1-5 Adenotonsillectomy evaluation
Moderate 5-10
Severe: 10-30
Extremely Severe: 30+

Children
Although this so called "hypersomnolence" (excessive sleepiness) may also occur in children, it is not at all typical of young children with sleep apnea. Toddlers and young children with severe OSA instead ordinarily behave as if "over-tired" or "hyperactive." Adults and children with very severe OSA also differ in typical body habitus. Adults are generally heavy, with particularly short and heavy necks. Young children, on the other hand, are generally not only thin, but may have "failure to thrive", where growth is reduced. Poor growth occurs for two reasons: the work of breathing is intense enough that calories are burned at high rates even at rest, and the nose and throat are so obstructed that eating is both tasteless and physically uncomfortable. OSA in children, unlike adults, is often caused by obstructive tonsils and adenoids and may sometimes be cured with tonsillectomy and adenoidectomy.
This problem can also be caused by excessive weight in children. In this case, the symptoms are more like the symptoms adults feel: restlessness, exhaustion, etc.
Children with OSA may experience learning and memory deficits and OSA has also been linked to lowered childhood IQ scores.

read this, the above came from this wiki article
http://www.apneaboard.com/wiki/index.php...pnea_(OSA)

Your actions.
I would ask for your daughter to be evaluated by a Pediatric ENT much sooner than October.  Assuming the surgery is appropriate ( sorry I can't help with that aspect ) You wanted to recover before school starts.
When sleep apnea is in play you want a physical (in your possession) copy of all sleep tests, diagnosis and prescriptions, electronic is OK as long as it is on your computer and not the net.  These are often needed when seeing specialists.

As others have said, in general, side sleeping helps, but don't force it on your daughter, just encourage it, Hey Gwendolyn, here is a neat Unicorn for you to snuggle into when you sleep.

[Sleeprider]

My concern with the study you cited is that there are no obstructive apnea, 6 centrals, and the hypopnea were diagnosed as obstructive.  I don't believe it. I think the hypopnea are central like the apnea, and the technician saw chest movement and called it obstructive.  Since the ENT is not available until August, ask your doctor if your doctor can be given a CPAP titration study. This is important because I suspect the CPAP will not succeed because her problems are not obstructive, which is also a clue on how essential the tonsillectomy is.  However if CPAP is successful, it will show your daughter has an obstructive sleep apnea disorder and may benefit from tonsillectomy or CPAP. I suspect it is idiopathic central apnea which has a different but similar positive pressure therapy, but one that uses pressure support to help the patient to maintain respiratory volume.  If this is central the surgery will not change it.  Although AHI is mild, the oxygen desaturation is significant, and would qualify for supplemental oxygen if her SpO2 drops below 88% more than 5 minutes through the night.  So another thing your doctor can easily do is to provide a recording oximeter to better document the seriousness of oxygen desaturation. This is an easy non-invasive test and will help make a decision on supplementing oxygen until another therapeutic approach is decided upon.

Sleep efficiency of 94.2% 
AHÍ of 3.8 episodes per hr
Supine AHI of 4.7
REM-AHI 0.0
Oxygen desaturation was documented to a nadir of 82% in association to respiratory events.



Respiratory data:
Patient had 0 obstructive apenas 
6 central apenas
21 obstructive hypopneas
Average apnea-hypopnea index of 3.8 per hr.

[cathyf]

Not many Obstructive Apnea, but a significant amount of Hypopnea. Hypopnea are 50-80% restriction vs Apnea which are 80-100% restricted. Either of these must have a time duration of 10 or more seconds, or they aren't defined as Apnea or Hypopnea.

One thing that confused me is that my APAP reports anything over 80% as obstructive, while the sleep lab that did my studies uses 90%. I couldn't figure out why my sleep studies show virtually all of my events as "obstructive hypopneas" while my APAP reports probably 10-1 obstructive apneas to hypopneas. I'm thinking that my obstructive events must mostly be between 80% and 90% obstructions.
...a simple difference in nomenclature makes things more confusing. These things are all confusing enough!

[Sleeprider]

Well the O.P. has not followed up with a post, so I may be speaking to dead air, but I wanted to link to another pediatric case we had recently where ASV turned out to be the solution after years of doctors treating the 9-year old child with CPAP, BiPAP and ST. http://www.apneaboard.com/forums/Thread-...s-on-bipap