Titrating child

[OutaSync]

I had the chance to run an overnight oximetry on my grandson Friday night. He had seven events (at least a 4% drop for a minimum of 10seconds) that 24.9 seconds, the lowest dropping to 86.

Question: To get a baseline on him, should I run him on CPAP of 5 or APAP from 5-20?

Background: He is almost 11. His mom and I have OSA. His mom is not compliant, although she did take one of my extra Activas home with her and promises to try again. Grandson has snored since he was a baby and wakes with night terrors, drenched in sweat and heart racing. Parents don't have insurance.

Last night I tried him on APAP with the smallest full face mask that I had. He slept for awhile and then knocked the cushion loose, got a very dry throat, couldn't sleep and turned off the machine. He had an AHI of 13.4 with average leak of 46.26. One large leak showed.

RestedGal, if you are still online, what do you think?

Bev

[rested gal]

I had the chance to run an overnight oximetry on my grandson Friday night. He had seven events (at least a 4% drop for a minimum of 10seconds) that 24.9 seconds, the lowest dropping to 86.
---
Parents don't have insurance.

Given those two things, I think you're doing the right thing, either way you go about it:

Question: To get a baseline on him, should I run him on CPAP of 5 or APAP from 5-20?

Straight 5 for a baseline. Then 5 - 20 to start tweaking treatment.

The boy is lucky to have you as his grandma.

[OutaSync]

Thanks, RG,

This child is very intelligent (don't all grandmothers think that?) I want him to have the best chance at keeping those developing brain cells alive.

Bev

[Georgio]

Way to go Outasync. From an earlier post of mine, "Sleep Apnea also goes undiagnosed in children who have little chance to seek help on their own. Since my primary care provider does not screen adults for apnea (he will after I discuss my case with him), I'm sure it doesn't enter his mind to evaluate children or adolescents. My conclusion is that we need to be on guard for youth than can't recogize the symptoms or seek help." My remarks grew out of my concern for my grandson.

He is a fortunate grandson, I'm sure you will get him on therapy and he will do fine.

Georgio

[john_dozer]

The treatment for childhood apnea can be different than adults. My nephew had problems sleeping with bad dreams. He tested positive. They treatment was to remove his tonsils and adenoids. His problems sleeping seemed to go away. I don't believe he had a followup study though. Now that its been a year and he's adjusted to the surgery, I think getting him checked might be warranted.

Anyway hate to suggest a treatment without a study, but if there was other cause to have the tonsils and adenoids removed, it might be beneficial for his sleeping.

Its also worth noting it was felt his tonsils and adenoids were the cause of my nephew's issue. Lots of sore throats and sinus infections seems to have mostly disappeared too.

[Bluebonnet_Gal]

Thanks, RG,

This child is very intelligent (don't all grandmothers think that?) I want him to have the best chance at keeping those developing brain cells alive.

Bev

I agree with Rested Gal, the boy is very fortunate to have you as his grandma! I understand your concerns and you're doing the right thing!

[Georgio]

Very good point John_Dover, "In most children, adenotonsillectomy is a first-line treatment for obstructive sleep apnea syndrome", from the following link: http://www.aafp.org/afp/20021001/practice.html

[rested gal]

The treatment for childhood apnea can be different than adults. My nephew had problems sleeping with bad dreams. He tested positive. They treatment was to remove his tonsils and adenoids. His problems sleeping seemed to go away. I don't believe he had a followup study though. Now that its been a year and he's adjusted to the surgery, I think getting him checked might be warranted.

Very good point, John. Glad you mentioned that.

The problem, however, goes back again to this, unfortunately:

Parents don't have insurance.

So, unless/until they can find a sympathetic and knowledgable doctor to take up the cause of examining and treating this child for free, I guess what OutaSync is trying is about the best thing to do for the time being. To help the boy get air while he sleeps.

As you say, John, even after removal of tonsils and adenoids (if they are the main cause of OutaSync's grandson's problem) it would be advisable for him to have a sleep study down the road, to see if that's all that was causing the problem. Money for exams, money for surgery, money for followup study... money that the parents may not have, as much as they would want to do whatever it takes for the health of their child. Enter grandma, to do what she can.

[-SWS]

Question: To get a baseline on him, should I run him on CPAP of 5 or APAP from 5-20?

I personally don't know much about the various caveats of pediatric titration. But I'll offer a couple questions for consideration. The questions will be based on the premise that APAP algorithms can "run away" with their top-end setting of 20 cm.

1st question- Are there any pediatric conditions such as asthma or inner ear complications that might contraindicate sustained runaway pressures of 20 cm for an eleven-year-old child?
2nd question- Can a normal, healthy pair of eleven-year-old lungs still be susceptible to any barotrauma from a sustained exposure to that hypothetical 20 cm runaway pressure?

I have heard that infants in pediatric units can frequently receive bursts as high as 20 cm. But I am also aware that those bursts would be neither sustained nor absent of a careful screening by either a pediatrician or especially a pediatric pulmonologist. So my above two questions summarized: is a wide-open range of 5 to 20 cm guaranteed to be a safe APAP range for an eleven-year-old child who hasn't been thoroughly evaluated for contraindications or barotrauma susceptibility?

Good luck, OutaSync! But please be very careful with that precious grandson...

[john_dozer]

The problem, however, goes back again to this, unfortunately:

Parents don't have insurance.

True, but the cost of a titration is probably in the neighborhood with the cost of the surgery. I suspect the cost of a good CPAP machine and a child's mask is comparable expensive again. There is no easy solution to that issue no matter what the course of treatment is. However, the more mainstream the procedure is, the more likely some kind of aid or coverage may be available.

I would suggest the child be enrolled in a SCHIP program now, if eligible, prior to any professional diagnosis. In fact who posted this thread again? Must be my apnea making me forget...

[OutaSync]

Thanks, alll.

[AuntieNae]

You are definitely in our prayers!

[Linus]

I recall that the minimum weight for usage is 30 kg. You may want to reduce the upper pressure. I agree with the statements about sustained pressures of 20 cm H2O.