Help in understanding sleep study report

[Suzanne]

Hi everyone i'm new site and wondered if any of you can tell me about a report from a consultant from a sleep study on my 22mth old son the report indicated there is a mild obstruction and that his breathing pattern is as follows pauses for 15seconds with minor desats >85% mild increased inspiratory resistance. carbon dioxide: ET/tc was recorded at 5.5-6.5 max 7.4
Any help in understanding this would be great i haven't yet got a follow up appointment with the consultant so thought it would be good if i at least had an idea of what all this means.
Suzanne

[deltadave]

Hi Suzanne:

22mth old son the report indicated there is a mild obstruction and that his breathing pattern is as follows pauses for 15seconds with minor desats >85% mild increased inspiratory resistance. carbon dioxide: ET/tc was recorded at 5.5-6.5 max 7.4

The scoring criteria for children, especially young children, is very different from adults.
An obstructive event of 15 seconds in a 22 month-old is not mild, nor is a desat to >85% minor. For that matter ETCO2 of 7.4, and I assume you're someplace where they use kPa for measurement values, is abnormal as well.
What's the total AHI, % of time spent over ETCO2 kPa 6.7, and the length of time they use to score a respiratory event?
deltadave

[Suzanne]

Hi thanks for the reply being new to all this i still don't yet understand certain things. What is a kPa and what do you mean by AHI % as none of this is on the report its kind of very basic.
The things they tested were SaO2, Pulse, Respitrace bands x2, Transcutaneous CO2, End-tidal CO2 ECG, Heart Rate, Video.

and the following was listed on report
BREATHING PATTERN: Pauses up to 15s with minor desats>85% mild increased inspiratory resistance

CARBON DIOXIDE: ET/tc: Mostly 5.5-6.5 max 7.4
HEART RATE & RHYTHM: normal
mild obstruction only

RECOMMENDATIONS: NIL specific

the time he was on the study was 8pm till 6am but he did wake up a few times during the night but just lay still.
I'm not aware that the consultant wants to see us till june should i push for an earlier appointment. I dont have anyother info appart from what i have given you above if you could tell me what you mean with your last question i could phone then and find out.
Thanks Suzanne

[deltadave]

Hi Suzanne:
The report that you have is a summary, see if you can get the "Long Report".

In there, among other things, is the number of apneas and hypopneas (obstructed breathing episodes) averaged per hour (apnea-hypopnea index) or AHI.

Based on the number of OBSTRUCTIVE apneas per hour, surgery is recommended, a tonsillo-adenoidectomy (assuming the little guy still has them).

An AHI of more than 1.0 is abnormal. Our place recommends surgery over 3.0. By 5.0 most people recommend surgery. AHI over 10 is severe. This is substantially different from what we use in adults.

Also the time requirement for an apnea in kids is different. We use missing 2 breaths, which is like 6 seconds. That's important to know, because if they are using the adult criteria of 10 seconds to rate an apnea, then they could miss a heckuva lot of events.

Regardless, a 15 second obstructive apnea in a child is a LONG apnea.

Oh yeah, that's the other thing, make sure the apneas are obstructive. CENTRAL apneas up to 20 seconds can be normal, especially in REM. Gotta be careful though, cause central apnea in kids can very well be obstructive, it can be subtle, so we report out all of centrals regardless of duration and then go from there.

For ETCO2, if the % of time over ETCO2 50 mmHg is greater than 8%, surgery is recommended. Any ETCO2 over 53 mmHg, regardless of duration, same thing. Your lab must use a value of kPa instead of mmHg to measure ETCO2 (you in England?) tell me what you've got and I can convert it. ETCO2 of 50 mmHg is about 6.7 kPa, so that's what we have to look for.

Any desaturations into the 80's will certainly perk up your ears in youngsters, but I don't know of anyone who uses desats as a surgical criteria.

Yeah, I wouldn't wait till June.
deltadave