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Helenhall
Unread post  Post subject: Need help understanding the sleep study report  |  Posted: Wed Dec 20, 2017 1:41 pm

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My 7 years old daughter had a sleep study done and the report came back with AHI 12. Her ENT wants to remove her tonsils and adenoids b/c her AHI is so high. But I noticed the ENT only looked at AHI and nothing else on the report, for instance her AHI is high mostly due to high hypopnea and apnea was 1. Jason can I get a paid phone consultation with you to help me better understand the nuances of the report beyond the AHI? Also what other professionals can I seek for second or third opinion? Pls email me directly for the details of phone consult if possible, thank you! Sorry the photo attachments of the report is slightly out of order.


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Helenhall
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Fri Dec 22, 2017 4:36 pm

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Since I haven’t heard from Jason, I like to open the question up to everyone. Can anyone have any opinion on if AHI 12.4 is almost all hypopnea and only 1 apnea on a 7 year old should still consider removing tonsils and adenoids. My daughter does prefer to sleep upright, before I knew she had OSA even if I pull her down flat, but in the morning I would often see her upright again. Any advice on what professional advice I should seek?


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LSAT
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Sat Dec 23, 2017 6:04 am

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I am not an MD and I don't recall any being on this board. I don't think any of us can give you a good answer to your question. Best advice I can give you is to get a second opinion from a qualified ENT....best would be one with a sleep specialty.


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Pugsy
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Sat Dec 23, 2017 9:52 am
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When it comes to children and OSA from what I have read the 12 AHI is considered fairly high for a child and removal of the tonsils and adenoids is usually the first thing that is suggested when it comes to children and OSA.
Often it fixes the problem and no need for cpap.

I am not surprised that the only thing the ENT looked at was the 12 AHI.
For kids that is considered quite high. I once asked a sleep tech how many was too many for a child...he told me AHI of 1 was too much.
Kids don't have the same criteria as adults.


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Helenhall
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Thu Dec 28, 2017 2:07 pm

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Thank you for the responses. So since the AHI gives same weight for apnea and hypopnea, does that mean they are equally bad? I would have thought apnea has got to be worse than hypopnea since no air is getting in at all.


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cindyY
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Fri Dec 29, 2017 1:57 pm

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If I understand it correctly, it is the oxygen deprivation that makes the difference between obstructive apneas and hypopneas. Jason does have a video on YouTube about children with sleep apneas and says the criteria of a sleep apnea diagnosis in children is an average of ONE event per hour as opposed to 5 events in adults.

I think Pugsy's right about the surgery being step one. My niece had her tonsils removed for this reason and has had no issues since. She was a toddler at the time and in her 20s now.

If you are uncomfortable with the diagnosis, I agree with LSAT, find a specialist for a second opinion, but do it quickly. And I would have your daughter start sleeping upright, since that is what her body is doing to try to relieve the problem.


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ajack
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Fri Dec 29, 2017 2:04 pm

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It's going to be either cpap or an operation is my guess. adenoids are a common enough problem with kids and snoring/apnea
This will help you get your head around breathing disorders
https://www.youtube.com/watch?v=-gie2dhqP2c


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ColoradoMom
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Fri Dec 29, 2017 6:29 pm

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I am also the parent of a child with sleep apnea. I am not an expert, but perhaps some of the knowledge I have gained thru my family's experience can help give you some incite.

Hypopneas are significant. A hypopnea is scored when oxygen saturations drop by a certain percentage (3-4%) for a specified amount of time. Over time oxygen deficits can cause damage to the brain and cardiovascular system, so your daughter's sleep apnea is a problem that should be addressed. Sleep apnea also causes multiple awakenings throughout the night which can impact a child's mood and cognitive abilities.

Removing the tonsils and adenoids is typically the first line treatment considered for children, and the success rate is very high. In my son's case his doc didn't recommend removing his tonsils because they aren't large, and she believes other anatomical features are causing his obstructions. Our insurance actually required a phone consultation with the doctor before approving CPAP because my son still has his tonsils and their standards list removing the tonsils as the first line treatment for pediatric sleep apnea. Before this I never would have imagined myself considering any kind of surgery, but if my son's doctor thought that a tonsillectomy would alleviate my son's sleep apnea I would do it in a heart beat. CPAP has helped my son tremendously, but it is not an easy treatment. My son has wonderful, supportive friends, but I know it's hard on my son to have to put on the mask and hook himself up to a machine at every sleepover. CPAP is a great treatment, and I would never discourage anyone from using it, but if there were another avenue for my son to take I would try it.

As far as what type of doctors to see for a second opinion, I would recommend a Pediatric MD of sleep medicine and ENT or Pulmonolgy. The internet provides a wealth of information, but only a doctor who has physically examined your daughter can answer whether or not she would benefit from surgery.

My son is older than your daughter, he is a teenager.
We live in a small town and it is was a long road to finding the right doctor who ordered a sleep study and figured out that my son has sleep apnea. My son's long term sleep and oxygen deficits had a tremendous negative impact on his live. He went from a honor roll student to failing all of his classes and he eventually fell into a deep depression. I have been astounded by how much CPAP has improved my son's life. He thriving once again, he is on track to earning straight A's on his report card this semester, and most importantly he is happy again.

Your daughter is lucky that you have found the right diagnosis so early on, treating her sleep apnea will likely save her from all kinds of problems down the road. Your daughter is fortunate to have such a caring and persistent Mom. Good luck to you, I hope you are able to find a doctor you trust!


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Helenhall
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Fri Dec 29, 2017 10:02 pm

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Wow that video was so helpful, thanks ajack. And thanks for the supportive words ColoradoMom. I’m much more receptive to the idea of removing tonsils and adenoids now. I’d never dreamt my daughter has apnea b/c she never displayed any obvious signs. I only got her checked out b/c her sister has apnea. Btw her sister had her tonsils and adenoids removed this Tuesday and today she told me it’s so much easier to breathe at night now. Does anyone know where I can find info on how much time children of various ages should be in stage 1,2,3 REM sleep? Thanks in advance.


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TheLankyLefty
Unread post  Post subject: Re: Need help understanding the sleep study report  |  Posted: Fri Dec 29, 2017 10:58 pm
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Helenhall wrote:
I’m much more receptive to the idea of removing tonsils and adenoids now. I’d never dreamt my daughter has apnea b/c she never displayed any obvious signs. I only got her checked out b/c her sister has apnea. Btw her sister had her tonsils and adenoids removed this Tuesday and today she told me it’s so much easier to breathe at night now.
Hi Helen. Sorry I didn't respond. I didn't see this until just now.

Looks like you already found most of the answers. Tonsils and adenoids being removed is first line for kiddos. CPAP might be effective too, but because they're still growing you end up with facial deformations from wearing CPAP at night when they do most of their growing. Often, the airway is just too crowded which makes removing the better option.

With kids hypopneas or apneas doesn't matter. Any breathing abnormality is considered an apnea.

Helenhall wrote:
Does anyone know where I can find info on how much time children of various ages should be in stage 1,2,3 REM sleep? Thanks in advance.
From memory it's 1/2 (25%), 3 (50%), and REM (25%). I could be very off on that, but I think it's ballpark.

Removing tonsils is routine for apnea in kids. I would do it if my 6 year old had a problem with it. :)

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