Son Finished Home Sleep Test - Possible UARS?

[Skeptic]

Hello guys,

My son finished his LOFTA sleep test yesterday. These are his results:

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Start Study Time: 10:26:26 PM End Study Time: 4:54:35 AM Total Recording Time: 6 hrs, 28 mins

Total Sleep Time: 5 hrs, 52 min % REM of Sleep Time: 29.7

Total Events pRDI: 107 (REM: 29.7, NREM: 13.6, All Night: 18.3) 
pAHI 3%: 27 (REM: 8.7, NREM: 2.9, All Night: 4.6) 
ODI 3%: 27 (REM: 8.7, NREM: 2.9, All Night: 4.6) 
pAHIc 3%: 1 (REM: 0.0, NREM: 0.3, All Night: 0.2) 
% CSR: 0.0 pAHI 4%: 13 (REM:, NREM:, All Night: 2.2) 
ODI 4%: 11 (REM:, NREM:, All Night: 1.9)

Oxygen Saturation Statistics: Mean: 94 Minimum: 90 Maximum: 99 Mean of Desaturations Nadirs (%): 93

Oxygen Desatur. %: 3-9: 27 10-20: 0, 20: 0

Pulse Rate Statistics during Sleep (BPM) Mean: 67 Minimum: 48 Maximum: 111


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Based on the results of this study, he has an AHI of 4.6 and RDI of 18.3. He is sixteen years old, 5'9, and approximately 170 lbs. He has been complaining about excessive daytime tiredness, which is excaberated during the evening. The Lofta people have sent the results with no diagnosis and consequently no prescription, because "... your results have come back normal and you do not have sleep apnea based on the Sleep Study report... A prescription for treatment has not been authorized at this time". Is this automated diagnosis accurate? I'm thinking about taking him to get a formal sleep study done. 

Thanks for your feedback,
A concerned parent

[gainerfull]

I'm not a doctor but the diagnosis does seem to suggest the possibility of UARS given the low AHI and higher RDI. What's his sleep hygiene like?

5'9" 170 is a little on the heavier side for a 16yr old boy - is he an athlete or is there an opportunity to optimize his health further?

[Sleeprider]

Although his AHI falls within a range that is not normally qualified for CPAP reimbursement by insurance, that alone is a rather arbitrary diagnosis. His high RDI and daytime sleepiness (Epworth score) may merit more consideration for therapy. This test and other health concerns could be considered by his primary doctor for hoa solution that may or may not include CPAP. A home sleep test is not the most sensitive measure, and it's kind of surprising that a 16 year old is borderline for sleep disordered breathing. If CPAP is considered, a device like the Resmed Airsense 10/11 that provides a bilevel pressure using EPR will work better to reduce flow limitation (UARS) than a single pressure CPAP. Not all CPAP is created equal. Other considerations are of course full evaluation of health, weight and even sleep position. This article shows how important sleep position can be, whether he is a CPAP user or not. https://www.apneaboard.com/wiki/index.ph...onal_Apnea It seems likely positive pressure may be helpful if not medically necessary, but that is between his doctor, the patient and you as his parents. We have had pediatric users of CPAP on here, and while SDB is unusual in younger individuals, it's not unheard of. If you want to pursue CPAP therapy, Supplier #30 offers a prescription service that would likely find him to be a candidate for CPAP. While there may not be insurance reimbursement the Resmed Airsense 10 Card to Cloud version is very reasonably priced and might be something to consider.

[Skeptic]

Thanks for the response. We don't monitor his sleep hygiene too much but he goes to sleep at 10 or 11 PM and wakes up at 6 AM for school. He probably goes on his cellphone or computer before bed, but I'm not sure if that would affect sleep apnea. Regarding his weight, he has been working out every day in the gym and has put on some mass (from 155 lbs in the beginning of autumn). He's not an athlete but does exercise regularly.

[Skeptic]

Thanks for the suggestions for the CPAP machines. Insurance would be helpful but is ultimately not needed; we can pay out of pocket for a CPAP machine. That being said, my son does not currently have a prescription to obtain one, but I think that his results warrant some kind of diagnosis that would allow us to purchase one. I think our best course of action is to bring him into the lab test - agreed it is quite abnormal to see a sixteen-year-old presenting with sleep apnea symptoms, given neither me and my wife have a genetic history of this and currently sleep quite healthily. In fact, I purchased the at-home-test at his request with some uncertainty, because I have never heard of sleep apnea affecting someone at such a young age, but the results suggest at least a mild disruption of his sleeping routine, for which treatment could be consistent for that of OSA.

[Sleeprider]

A positive sleep test is not the only criteria for a prescription. As I mentioned, Supplier #30 offers a prescription service based on a questionnaire and the sleep test shows a borderline condition that could be treated with consideration of his other symptoms of sleepiness. You may be surprised that his doctor may agree with you and provide a Rx. Sleep tests and the AHI > 5 was contrived by insurance to limit their exposure to claims. A doctor's judgement (and yours) is far more relevant than a policy. Sleep tests are very expensive and uncomfortable, and provide very limited useful information.

[srwilsn3]

If money is not an object, I would definitely recommend an in-lab study. Although older (35), I am a similar height and weight (5'10 and a leaner 170lbs). I did not fit the "typical" profile of a sleep apnea sufferer but I had a lot of the telltale signs (daytime sleepiness, frequent wakings, waking up choking). After insisting on an in-home study, the results did not show OSA. Finally I got a lab study and it confirmed OSA, though my numbers were quite low. I am thankful to have a diagnosis so I can continue to seek appropriate treatment.

There is night to night variance on apnea events. What's more, in home tests are low reliability. An in-lab test will be important to ruling out problems. Do this before you purchase a CPAP for him, as CPAP therapy (while so incredible for those for whom it's indicated) is not something someone will want to start if there is no need.

In the meantime, strongly consider his sleep hygiene. Waking at 6am is quite early for a teenager. Teenagers' circadian rhythms are different than adults'. This cannot be discounted as a contributor to his tiredness. When I was 15, I had to wake at 5am for a paper route. For the entirety of the time I delivered papers, I was very tired through the day. I strongly recommend he try to improve his sleep hygiene, given it is simply hard for a teenager to wake that early. No caffeine late in the day; no screens in bed; regular cardio. Even if he has UARS or OSA, changing these things has been shown to independently improve sleep quality.

[BoxcarPete]

Questions for you:
Does he snore at night? Does he still have his tonsils and adenoids? If so, have they been looked at by an ENT?

The arousal index is way higher than the apnea index because the score appears to count apnea based on O2 desaturations. Someone who is young and in good health will be able to compensate for breath holding with cardiac exertion to maintain blood oxygenation. This is not something that you want to continue, as it will likely lead to structural heart changes and hypertension later in life.

I don't mean to scare you, but as an adult I'm working on my sleep quality again after getting 20-25 years of decent sleep following a tonsillectomy/adenoidectomy at age 8. When children have sleep breathing disorders it is most commonly related to something like oversized tonsils or adenoids. Your son is at the age where the adenoids should be shrinking along with other structural changes to his airway that differ between adults and children. If this is not happening properly, they are pretty easy to remove.