Can anyone help me interpret my son's sleep study report?

[SingleMom]

(I posted this on another board, but it's very slow, and I'm too ADD to wait) Can anyone interpret this report for me? I did notice discripencies (sp?) and will be talk with the doc soon.

My son can't be summed up easily, but I'll attempt it. He is currently 4yrs11months. He started rocking his head at about 2 weeks old, and banging at about 3 months. He was a lump (not even rolling) at 8-9 months old but never qualified for EI services. At 13 months he started walking, and at 14 months he was kicked out of his first daycare. He was a never-ending behavior battle, and still is. At 18 months he had PE tubes in his ears. At 19 months he cracked the back of his head during a temper tantrum resulting in staples. At about 2 he started with the specialty Dr train; neuro diagnosed hyperkensis and sensory integration dysfunction. GI diagnosed milk/dairy allergy. At 2yr9mo he started special ed preschool. At 3yr3mo he had his tonsils and adenoids out for assumed OSA (family history) and they were large. At 3yr9mo he had upper/lower scopes to rule out more severe issues and was treated with assumed reflux. Also had sleep study around the same time. (I'm going to post results below). Sleep study showed mild OSA with mild sleep fragmentation with recommendations being Observation. Just after sleep study he was diagnosed with asthma. He can now tolerate dairy, but we still avoid to an extent.

His current diagnoses are; PDD-NOS, ADHD combined type, severe SPD, ODD, asthma, severe speech delay, mild OSA (I know a lot of these overlap each other, and I think I'm forgetting something!)

On to the sleep report.

Sleep architecture
TIB- 502.0min
TST- 421.0min
Sleep efficiency 83.9%
Latency to sleep onset 47.5min
Latency to first stage R 132.5min
5 periods of stage R

Staging and body position
N1- 3min 0.7%
N2- 86.5min 20.5%
N3- 999.9min 52% (numbers copied from report, I realize the 999min is wrong)
Stage R- 112.5min 26.7%

Resp. Parameters
20 apneas in total (1 obstructive, 19 central)
38 total hypopneas
AHI 8.4 in stage N
AHI 8.0 in stage R
Total AHI 8.3
RDI 8.4 in N
Rdi 8.0 in R

End Tidal CO2
ETCO2 was above 50 mmHg for 99.9 % of TST
Peak ETCO2 47mmHg

Oximetry
Mean SpO2 96.5%
Minimum 80.0%

Arousal and Limb
38 arousals in total (5.4 events/hour)
30 were spontaneous (4.3 e/h)
8 associated with resp. events (1.1 e/h)
0 associated with limb movements
0 limb movements in total

ECG- no cardiac arrhythmias

So what are your "expert" (not a Doc) opinions on this report? Where do we go from here? I've also noticed sleep terrors, confusional arousals, rythmic movement disorder (all are unofficially diagnosed), and he is 100% diapers at night. My biggest problem is that my son has a family history of OSA. I have OSA and have CPAP, daughter has OSA but does well with melatonin.

ETA- change title

[kteague]

Hello, and welcome to the forum. Sounds like your son and you have quite a few challenges.I'm just weighing in while you wait for some more knowlegeable of your type of situation to reply. His prevalence of centrals and low oxygen would be the areas I'd want explained and dealt with. Who knows, once you get this all sorted out, how many areas may improve for him. Hopefully this is the beginning of his whole needs being diagnosed and successfully treated. Best wishes.
Kathy

[SingleMom]

Thank you for your reply. While I don't expect treatment in sleep issues to cure him of anything, I'd sure like to get some calm and happy out of him!

[Kiralynx]

SingleMom,

This is not related to the apnea, but check out http://www.pecanbread.com. The focus is mostly autism, but it has to do with food issues and sensitivities, and neuro issues, and etc. The page mentioned is the children's list -- I've followed this diet for 8 years -- and it's significantly helped my ADD inclination.

[SingleMom]

Thank you for the link. Both of my children have had and outgrown life threatening, epi-carrying food allergies. Becuase of this, their diets have been limited. For a number of years we avoided dairy like the plague and I cooked everything from scratch to avoid cross-contamination. I've never followed any diets out there for their autism or other behavioral issues, but due to allergies, they have been on about every combo of diets.

[Julie]

Have you looked into gluten free diets - there has been a definite connection made to OSA in some people.

[Kiralynx]

Thank you for the link. Both of my children have had and outgrown life threatening, epi-carrying food allergies. Becuase of this, their diets have been limited. For a number of years we avoided dairy like the plague and I cooked everything from scratch to avoid cross-contamination. I've never followed any diets out there for their autism or other behavioral issues, but due to allergies, they have been on about every combo of diets.

SCD is gluten-free, as mentioned by another poster, and it can be done dairy-free. With all your experience in home cooking and avoiding cross-contamination, you're about thirty steps ahead of those folks whose notion of "home cooking" is to take a frozen pizza out of the box and heat it in the oven.

I hope you'll consider it. I've seen it work miracles, and not just for myself.

[katherinefulmer]

I would rename your Subject, Singlemom to attract the attention of readers with a knack for reading data.

[SingleMom]

How do I rename or edit it?

[SingleMom]

Just bumping up to try and get more eyes.

[Muffy]

ETCO2 was above 50 mmHg for 99.9 % of TST
Peak ETCO2 47mmHg

One of those is wrong. You can't be above 50 all night long and have a peak of 47.

Muffy

[SingleMom]

There are quite a few issues with the report, and I'm hoping to have his pulmo address it soon.

[DYNE540]

Hi Single Mom,

I'm happy to see you being proactive in trying to get a clear understanding of your son's medical conditions. Many of us here in the forums didn't find out till much later in life that we had a sleep issue; I'm 34 and found out 6 months ago. early in life, I too was also diagnosed with ADHD at an early age and also had severe speech delay. In fact, doctors thought that i was mentally retarded. Boy were they wrong.

Not one doctor asked about quality of sleep until i pressed them to look into it. I noticed that once my own sleep apnea issues were dealt with i didn't need meds, did better in school, became more sociable, and happy in general. I'm willing to bet the more you press the doctors with your specific questions, and the forums, the better your son's health will become.

I can't interpret any of the data as i'm not an expert, but people like rooster and rested gal may be able to help.

Keep up the great work Single Mom,
DYNE540

[Muffy]

There are quite a few issues with the report, and I'm hoping to have his pulmo address it soon.

Well, I'd make sure that the ETCO2 value is correctly identified first. Anything > 8.0% of TST >50 mmHg ETCO2 is abnormal, so > 99.9% would be abysmal, and suggestive of an entirely different diagnosis.

Muffy

[rested gal]

I can't interpret any of the data as i'm not an expert, but people like rooster and rested gal may be able to help.

I appreciate your confidence, Dyne, but I bow out of sleep study interpretations. That's wayyyy over my head. Muffy is the one to pay attention to about PSG interpretations. Especially pediatric studies which are a WHOLE other ballgame.