I just got a copy of the sleep report. I know you guys are not "experts" in pediatrics, but there are no active peds boards. I know this report does look pretty good, but please remember we are *reaching* for something to treat. My son has tons of issues. Besides all of his behavior problems, IF I can ever get him calm for more than 5 minutes he will fall asleep. He still sleeps in the car, while watching movies, etc. He's 5. I'm going to see if Doc will prescribe auto machine with a very low (maybe 4-10) pressure setting and see if it helps his sleeping as well as improving some behavioral problems. What do you think? Do you think we have room - according to report - to try and treat something?

Sleep architecture
TIB 495.7
TST 397.3
Sleep efficiency 80.1%
Sleep latency 0:44:54
R latency 3:06:30
Wake after sleep onset 53.5
3 periods of stage R

Sleep staging (all sleep supine)
N1 27.5
N2 87.8
N3 222.5
S 59.5

Resp
1 obstructive apnea
1 central
12 hypopneas
Overall AHI 2.1
Non-REM AHI 1.4
REM AHI 6.1
No cheyne stokes

End tidal Co2 Highest recorded was 50.0mmHg
Mean SpO2 95%
Minimum SpO2 89%

Arousal
94 total
81 spontaneous
13 associated with resp events

No cardiac arrhythmias

Interpretation- Mild OSA with mild sleep fragmentation

SingleMom wrote:... Besides all of his behavior problems ... He's 5. I'm going to see if Doc will prescribe auto machine with a very low (maybe 4-10) pressure setting and see if it helps his sleeping as well as improving some behavioral problems. What do you think? Do you think we have room - according to report - to try and treat something? ...
:
Resp
1 obstructive apnea
1 central
12 hypopneas
Overall AHI 2.1
Non-REM AHI 1.4
REM AHI 6.1
:
End tidal Co2 Highest recorded was 50.0mmHg
Mean SpO2 95%
Minimum SpO2 89%
:
Arousal
94 total
81 spontaneous
13 associated with resp events
:
Interpretation- Mild OSA with mild sleep fragmentation

Well, it appears you've done reading to note the link between sleep disorders and behavioral problems with kids. For example:

http://www.webmd.com/add-adhd/guide/adhd-sleep-disorders

I guess I would caution you that the doctor might think that he does not need it, since it is mild. So, you might want to search for articles where a pediatrician notes the impact of poor sleep on children. As an example:

http://www.healthvideo.com/article.php?id=527

It always helps to be prepared when you discuss this with his pediatrician. Hopefully that will help. It certainly appears from the study summary (above) that your son's sleep is interrupted during REM sleep, which is a very important stage for everyone. And I would expect it to be extremely important for children. For example:

http://faculty.washington.edu/chudler/sleep.html

So, with a little research you might be able to help convince his pediatrician, especially if you do the research and note that you are trying to help your son be well adjusted and able to face school. Hope that helps.

The sleep Doc he sees did want to do another study due to his behavior. She also agreed that if his results were the same or worse from last time, that we could try and treat. I understand that in normal kids, his report would be "do nothing have a nice day," but with his severe delays and behaviors, we were looking to treat something.

Thank you so much for the links, I will read and print.

The other slightly concerning issue is that his ETCO2 was up at 50, but it doesn't say for how long. I know in peds, ETCO2 is one of the things they look at.

Singlemom,

It is certainly worth a try, having said that it can be very difficult to get your insurance to pay for OSA treatment in a child under the age of 7. There are 2 main reasons for this, not saying I agree with the first one, just letting you know from years of experience dealing with peds and OSA.

1. Most insurance companies want to try surgical options (ie. UPPP or Tonsilectomy) prior to trying any positive pressure ventilation. Many times surgery is a much cheaper option than positive pressure ventilation.
2. The only machines currently approved by the FDA for treatment of OSA in a child under the age of 7 or under 40 lbs. are home ventilators. These ventilators can run anywhere from $1,500 to $10,000 a month to rent and many times there is no option to buy for the insurance. There are machines approved for children over the age of 7 AND over 40 lbs. they are few though and still expensive. Respironics Bipap ST, Respironics AVAPS, and Resmed VPAP III ST-A, there may be 1 or 2 more I’m just thinking off the top of my head right now.

I’m not trying to scare you away from pursuing treatment for your son or to discourage you from the PPV path, just giving you a heads up as to the obstacles in the path.


AKCPAPGUY

Thank you for the info!

My son has T&A surgery when he was 3, so we got that covered. You're saying with the machines, it's 7 years AND 40+ lbs? He is over 40lbs, but obviously is not 7 yet.

I'll have to go look up the machines you mentioned.

Thanks

Yes, the ones I mentioned are only approved for children 7 and over AND over 40 lbs.

Even with adults, overnight in the sleep lab may not be reflective of how we normally sleep. In your case, I think a repeat study is a good idea to see if it yields any more clues.

Don't worry it will be all right.

SingleMom wrote:The other slightly concerning issue is that his ETCO2 was up at 50, but it doesn't say for how long. I know in peds, ETCO2 is one of the things they look at.

Right. And you need to get the %values >50 mmHg in this report and the other one:

viewtopic.php?f=1&t=45337&st=0&sk=t&sd=a

Although if Peak ETCO2 in this one is 50.0 mmHg, chances are pretty slim that %value >50 mmHg will be anything to worry about.

What medications is he on?

SingleMom wrote:Do you think we have room - according to report - to try and treat something?

Nothing that a CPAP machine would improve.

Muffy

Hi, I understand that you are responding to what seems like minimal, if any, OSA, but putting anyone on a machine starting at a pressure of 4 would seem like an immediate way to turn them off the machine, i.e. they couldn't breathe. If you want to try it, at least start him at 6 or so and avoid scaring him off forever. A lower pressure (4) does not correspond to a low AHI - it only reflects the amount of air needed to open his individual airway, not the number of times it might be needed.

The temptation to label him as needing Cpap now may be high, as you (and his MD?) are apparently tuned into it, but what, for instance, if he has ADD, and is exhausted because of that, rather than OSA, or because there are other factors having no relation to OSA? How far has his MD looked, as opposed to having (possibly... I wasn't there and don't know) been steered to look at OSA?

He isn't on any meds except pulmicort for asthma.