Questions about sleep study

[Evamarie]

The sleep study was for my 6yo daughter and I tried and tried to find numbers online to find out what was normal and how bad her sleep really is. Here they are our consult with the sleep doctor isn't for another 10 days.
CAI 3.4 increasing to 16.5 per hour during REM sleep
AHI 5.5 increasing to 24.2 per hour during REM sleep
most contributed by the central pauses.
OAHI 2.1 increasing to 7.7 per hour during REM (her OAHI was 0.1-0.5 last year in August).
Overall 14 obstuctive breathng events averaging 10.6 seconds and as long as 24.7.
They don't want to do a CPAP because they believe that she isn't swallowing her saliva which is what may be causing her obstuctive apneic events.
I would love it if someone can dierect me to where I can find out what is normal and what isn't.
Thank you a concerned mom
Evamarie

[DocWils]

In an adult, these would results would indicate the need for a CPAP normally, but I certainly understand the desire of the specialist to hold off and look at other causes, such as saliva blockage - this is indeed a problem that young people especially can have (and old people too, btw - the reflex sometimes goes away with age).

I don't think interpreting the numbers here would actually do much for your understanding, save the following notes - central pauses probably means the same as central apnoea events, and these are not caused by external triggers (blockages due to saliva, etc) but by the brain itself pausing the breathing. The causes can be various and it is not always something to panic about - at six there is still a lot of brain development going on and this can be grown out of or have other causes that may be addressed in simple ways. In adults an AHI of greater than 5 is defined as sleep apnoea in the clinical sense, however in children this number is a bit more fluid. The cause of cessation of saliva swallowing must be addressed, and this may be central to the whole problem. The key to this may be the key also to the central apnoea events.

The other area of concern would be the length of the events, and here the numbers would make for some concern, as an event of 24 seconds is far longer than skip breathing, long chain breathing cycles or other "normal" breath pauses can account for. She may need respiration therapy to develop normal breathing cycles in her sleep.

However, let me also say that if the results were cause for immediate concern, your appointment would have been pushed up. She has been living with this for a while now, and the next step is interpreting the results and figuring out the probable causes and building a therapy method for her.

I do not see grounds for any panic, although it is indeed worrisome for you. What is happening between the testing and the next consult isn't that the numbers are just sitting on a desk, but they are actively being dissected and consideration as to probable cause and therapy is being undertaken, so please feel confident that your medicos will do the best they can to find a good solution for your daughter. Some of this can be age related, and simple training can deal with this, other bits may need other forms of therapeutic solution. If she is currently on any form of medication, the dosage and the type of medication may need adjustment. I am certain she is in good hands.

[Shastzi]

Most curious, DocWils.

If someone is not swallowing their saliva in their sleep, how would you verify this?
With an MRI or something?

[trish6hundred]

Hi Evamarie,
WELCOME! to the forum.!
Hopefully you can get your daughter's problem straightened out.
Best of luck to you both.

[DocWils]

The sleep test has a choking detector of sorts - it can measure if breathing events end with an eruption, which usually is a cough, indicating the clearing of the throat, which is then deemed to be likely to have been caused by either saliva or mucous. It is then possible to test the amount of salivation normally produced by the patient before they clear it. It is a bit of black box medicine, but it is based on a lot of accumulated knowledge and testing that makes usually correct assumptions. MRIs are not only not necessary, but would probably not work in such a case. Back when I was first studying and dinosaurs ruled the earth, we used to put long cotton strings wound with something like Litmus paper into the mouth and let it trail out over the lip and chin and then measure how long it took to wet to certain levels - nowadays it is all done with tiny electronic sensors and swallow detectors placed outside the mouth, under the chin and around the throat. But it is only rarely used, since most sleep testing systems already produce enough data to make the assumption.

In addition, we look at the length of the uvula and examine the throat, nose, tonsils, etc, and see how they are all working and how much mucous and saliva is being produced. If the child has done the sleep test in the clinic, there is also video of the sleep, and it is usually pretty easy to see if someone is swallowing or not, especially children, who have very noticeable swallowing action.

So, a lot can be done by inference and then if need be backed up by further testing - usually it is not necessary, since most medical centres won't have the necessary equipment (the sort of sensors I was talking about are really only used for extreme cases and are not found in every hospital - since it is simply almost never needed and simpler means usually get the job done), and usually, unless you are talking about cases of hypersalivation or asalivation (I forget the English terms for these, but I am sure you get the idea) that level of measurement simply isn't necessary. For a girl that age, unless she completely ceased to swallow for twenty minutes at a time and has tons of saliva dripping from her mouth, this sort of testing wouldn't be performed, the video evidence and cough testing would be sufficient to make the diagnosis.

If there were other causes of the lack of swallowing other than reflex or malformation of the uvula or tongue, which can be confirmed visually, we would also see other things happening, like she would cough hard every time she swallowed, and maybe turned a bit blue and would be underweight, etc, indications of an oesophageal fistula. But that would be noticed waaay back already and she'd be long since on the table having it closed (did a few infants with that over the years). Here you have another set of problems - the girls doesn't get rest from her sleep, and she is observed during the sleep test either not swallowing as often as normal in sleep or coughing during apnoea events - these would indicate some sort of blockage other than tissue collapse, and the most common ones are mucous and saliva. If she doesn't have a strong post nasal drip, then saliva becomes the culprit - no need for expensive testing with sensors and what not....

[Evamarie]

Thanks everyone for your advice @Shastzi the way they discovered with our daughter was that she had surgery to fix her pallette the ENT on the after surgery check up went to check it and because of our concens of her gagging and choking at different times of day/night they did a swallow test where they used a camera that went through her nose FEEs. During the study food collected in her throat and he touched an area where a normal person would gag and she didn't. They then wanted to know how it affected her sleep. We are working with various specialists we are fortunate to live by a good children's hospital. I get impatient so wanted to know more sooner than later. I will be contacting some of the doctors tomorrow to see what we are going to do with this new information in connection with everything else. I did this early this morning because I couldn't go to sleep so I just went with the information that I could just read and type and wasn't wanting to go into all the nasty details just too tired to type it all.
The main reason I am worried because this result, a MRI, and the next two swallow test results will determine where we will go with my daughters treatment. She has a brain stem glioma (shown on earlier MRIs) which in most cases it has a high mortality rate but because she has NF1 the tumors are benign and grow at a very slow rate and may even just stop growing. If she doesn't have any major factors going on they would just keep an eye on it and do periodic MRIs. If major things are going on then they are going to do chemotherapy. With having NF the chemo they will use will make the tumor stop growing in a smaller amount it will actually shrink it. I promise I wasn't trying to keep anything back I was just too tired and emotionaly drained at 2:30 in the morning.

[Shastzi]

Evamarie:
Oh wow....
As far as Moms go, the only thing you may be missing is a cape.

Hang in there and keep on keepin' on!
(like my signature says)

Cheers, best of luck & don't forget to take care of yourself too!