"please keep me updated about oximeters "
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child 9 years old, AHI = 4.4, is that good? Problem? Whats the range?
Our behaviorally challenged middle child was sent for a sleep study to rule out sleep disorders. His special ed. teacher and the pediatrician had suspected seizures or something may be disrupting sleep. But we were all surprised by the results. The report recommended taking him to an ENT for evaluation of his upper airway. "The patient was noted to have central sleep apnea with AHI=4.4, the lowest oxygen saturation was 93%." Go figure, all the brainwave results were unremarkable. Can anybody help us understand these numbers?
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Replies to This Discussion
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Permalink Reply by RD on
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Hi, anything under 5.0 is typically good. The central apnea is where the brain forgets to signal the body to breath. An idea may be to have a neurologist do some tests to see where the issues lie. IF, he is having no signs of Obstructive Sleep Apnea (OSB) or hypopneas then that clues me to think about the neuro processes that are not occuring. In any case, a CPAP might help. But, keep an open mind and your options open.
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Permalink Reply by Jeanne Lyon on
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Thank you! If you have any other experience with kids/pediatric apnea, please share!
RD said:Hi, anything under 5.0 is typically good. The central apnea is where the brain forgets to signal the body to breath. An idea may be to have a neurologist do some tests to see where the issues lie. IF, he is having no signs of Obstructive Sleep Apnea (OSB) or hypopneas then that clues me to think about the neuro processes that are not occuring. In any case, a CPAP might help. But, keep an open mind and your options open.
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Funny, this child is the only person in the universe I've ever met who would probably LIKE a CPAP. He's always wrapping his face in tape/rubberbands/string !LOL! Either way, this household is pretty exhausted, whatever might make a dent in our total discomfort, we're willing to try it. And if we find that he needs treatment for apnea, and the treatment helps him function better, and we're all more comfortable, then Yay! Whether he's suffering apnea that's central or obstructive, we should try pretty quickly to get it figured out. I'm excited to think maybe he's not really "crazy", maybe he's just sleep deprived? This is exciting, I'm going to keep my fingers crossed. He's a smart and beautiful boy. I hope we can help him.
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Permalink Reply by RockRpsgt on
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An AHI<5 is ok for an adult, but not for a child. Twice the amount of physical and mental restoration is going on in children than adults. PLEASE take you child to the ENT and have his tonsils and adnoids checked. 60% of all children diagnosed with ADD/ADHD have some sort of sleep problem. It brings tears to my eys to think of how much my child could have been held back had myself and others not recognized a problem.
http://www.sleepguide.com/forum/topics/a-nine-year-old-sleep
http://www.sleepguide.com/forum/topics/adhd-vs-sleep-apnea?page=1&a...
http://www.ncbi.nlm.nih.gov/sites/entrez
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Permalink Reply by D. W. Conn on
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I am not comfortable with a child having an AHI of 3 or desaturation down to 93%. (I am not an MD only a lowly Technologist) Apnea events in children are measured differently. Where adults need a cessation of 10 seconds a child needs only the equivalent of 2 missed breaths.
A Child with central Apnea could be symptoms of other issues. Such as brain dysfunction in electrical pathways or even something to do with cardiopulmonary issues. Not trying to scare anyone but really look into this situation more thoroughly.
I would recommend you sit down with your pediatrician and have an in-depth discussion.
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The Polysomnogram Summary Report stated "The patient's Sleep Efficiency was lower than expected in a sleep laoratory environment. The Total Sleep Time was acceptable for providing a valid evaluation. The patient experienced a normal amont of arousals and stage changes. The Sleep Latency was delayed. The REM latency was delayed. A normal REM latency is appx. ninety minutes. The amount of slow wave sleep was increased. REM sleep was decreased."
"The patient was noted to have central sleep apnea with apnea hypopnea index of 4.4. The lowest oxygen saturation was 93%"..."also there was one obstructive sleep apnea"
"Diagnosis ICD-9 327.21 *Primary Central Sleep Apnea."
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Permalink Reply by Mack D Jones, MD, SAAN on
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ENT referral is appropriate. Recheck sleep study after the Tonsillectomy and Adenoidectomy. Hopefully the AHI will be 0.
It is possible that the centrals are the result of longstanding obstructives. Once the airway is opened, the problem may be resolved. If not, a good pediatric neurologist should be consulted (I'll bet that the peds neurologist won't be necessary).
By the way, an AHI of 1 is abnormal for a 9 year old, whether it is obstructive or central. I'll be surprised if there isn't significant improvement in behavior postop as well. Good luck.
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Thank you very much. A referral was also made to Children's Hospital in Chicago for a "children's developmental specialist", with the warning that an appointment will take 9 months or more (long waiting list). If you can think of anything we could do more quickly, please share. I'm glad you took the time to read my post here and respond, I really appreciate any knowledge you could share.
Mack D Jones, MD, SAAN said:ENT referral is appropriate. Recheck sleep study after the Tonsillectomy and Adenoidectomy. Hopefully the AHI will be 0.
It is possible that the centrals are the result of longstanding obstructives. Once the airway is opened, the problem may be resolved. If not, a good pediatric neurologist should be consulted (I'll bet that the peds neurologist won't be necessary).
By the way, an AHI of 1 is abnormal for a 9 year old, whether it is obstructive or central. I'll be surprised if there isn't significant improvement in behavior postop as well. Good luck.
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Woops! Children's Hospital's developmental dr. will only see children under 7 years old. So instead of that route, we have an appointment with the pediatrician who ordered the sleep study, in 2 weeks, to discuss his medical history (asthma vs CF, heart murmur, low central tone, family history of celiac, he's been gluten free 4+years for typical celiac symptoms) . Will try to get into the ENT soon, then, based on this SleepGuide discussion, hopefully seek a pediatric neurologist who's been thru this before. Wouldn't it be nice to see improved function in our smart, beautiful boy? What if he could really reach his true potential after all?
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Is that End Tidal Carbon Dioxide Distribution? Its in a little chart on this report. At the end of the chart, the Avg for REM is 45, for NREM is 45 and the Total (TIB) says 45. But in the columns marked >30,>40 etc the NREM values are much higher than the REM values, ie 39 for REM and 341.6 for NREM, and every column has that sort of difference. What does that mean? And thank you for trying to help!
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The columns in the End Tidal Carbon Dioxide Distribution chart under >50 says 0.0 for REM, 8.7 for NREM and 9.2 for Total(TIB), then each column >55, >65 and >75 are all 0.0 for each.
Mollete said:The important values would be, specifically, Maximum Observed ETCO2 and % of Time spent > 50 mmHg.
mollete
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