Got my daughter's study results

Would love some help decoding it all. I understand most of it except for this

There were 31 obstructive apneas, maximum 18 seconds with a mean of 10.8 seconds; 2 mixed apneas, maximum of 13 seconds with a mean of 13.2 seconds; and 27 partial obstructions, maximum 25 seconds with a mean of 11.9 seconds. The overall AHI was 7.6. REM index was 9.1 and non-REM index was 7.3.

Sleep Analysis: Shows no significant sleep disruption

Respiratory Analysis: Shows moderately increased obstruction with decreased mean saturation and mild hypoventilation.

Impression:
Diagnosis and Recommendations:
1. Moderate obstructive sleep apnea with hypoventilation and low mean saturation. This combination of findings suggests a more significant respiratory abnormality than would be implied by overall apnea frequency alone. Regardless, this degree of abnormality typically warrants intervention.

2. Low mean saturation. This finding is seen in patients with upper airway obstruction, but can also be present in patients with underlying small airway disease such as asthma, intrinsic lung disease, pulmonary hypertension, or cardiac shunt. Suggest Clinical Correlation.

3. Mild hypoventilation. This finding can be seen in patients with long-standing obstructive sleep apnea, but can also present in patients with neuromuscular or chronic lung disease. Suggest Clinical correlation,

When do you meet with the doctor for an interpretation of the findings?

I wouldn't be comfortable offering an interpretation as I don't know anything about hypoventilation in kids. Also not sure what they mean about the saturation, but I'm assuming her oxygen saturation wasn't what they wanted to see. The only part I understand is that her AHI is >1 (less than 1 is normal in kids). You'll have to ask the doctor what other tests need to be done to work her up, as well as whether your thoughts about surgery are still relevant.

SleepingUgly wrote:When do you meet with the doctor for an interpretation of the findings?

I wouldn't be comfortable offering an interpretation as I don't know anything about hypoventilation in kids. Also not sure what they mean about the saturation, but I'm assuming her oxygen saturation wasn't what they wanted to see. The only part I understand is that her AHI is >1 (less than 1 is normal in kids). You'll have to ask the doctor what other tests need to be done to work her up, as well as whether your thoughts about surgery are still relevant.

I don't meet with her doctor. They immediately sent her to an ENT to talk about a tonsillectomy which I'm not sure I'm comfortable with considering her issues seem to be more asthma related.

We meet the ENT on Tuesday and I have no idea what to even ask about

Can't you insist on an appointment with the sleep doctor to explain the sleep study findings? I would not expect an ENT to be able to explain all this adequately.

DOES she have asthma?

SleepingUgly wrote:Can't you insist on an appointment with the sleep doctor to explain the sleep study findings? I would not expect an ENT to be able to explain all this adequately.

She doesn't have a sleep doctor. Her pulmonologist ordered the tests. She does has Asthma and was diagnosed at 4 months old.

It looks like the ENT she is seeing does specialize in Sleep Apnea

http://www.otolaryn.com/Default.aspx?m= ... ces&s=Main

Ugh I hate that I'm being thrown into this in this way

So how about an appointment with the pulmonologist to go over the results?

SleepingUgly wrote:So how about an appointment with the pulmonologist to go over the results?

She's booked 5 months out which would put us after school started But she does have an appointment in September with her

Here's a study I'm reading that has me wondering

http://www.drugs.com/news/children-may- ... 29266.html

Children who get Tonsillectomy's are more likely to gain weight. My daughter already has some weight issues. This stuck me too

For children with breathing-related problems, the authors suggest trying continuous positive airway pressure (CPAP) before resorting to surgery. Also, doctors should make dietary and lifestyle recommendations for young tonsillectomy patients, they say.

Of course I will listen to what the doctor has to say but I want to have knowledge before going also. I want to be aware of things that I might not be told

You may have to be assertive about getting your daughter in with the pulmonologist sooner. If you tell the office staff that you can't wait that long to get the results of the sleep study because you have to make treatment decisions this summer, maybe they will get you in sooner. If they still tell you that you can't see the doctor in that time frame, insist that the doctor call you. Do you have a good relationship with the doctor? Is he/she in private practice? Remember, the squeaky wheel...

I've never heard of the weight gain due to tonsillectomy theory. Here's one explanation for it, though:

http://www.jpeds.com/article/S0022-3476 ... 9/abstract

Did you say your daughter's tonsils are large?

I think you are going to need a competent doctor to help you sort out whether the results of the sleep study suggest that a T&A (tonsillectomy & adenoidectomy) would help. Ideally this would be a pulmonologist who is also a sleep doctor. If your pulmonologist doesn't fit the bill, you may need to get a second opinion from another one who is a sleep doctor. Of course an ENT can weigh in, but most ENTs won't be able to speak to this hypoventilation/obstruction/etc issue. Are you near a large city? There ought to be more doctors to choose from. Maybe your sleep doc can recommend someone in pediatrics.

SleepingUgly wrote:You may have to be assertive about getting your daughter in with the pulmonologist sooner. If you tell the office staff that you can't wait that long to get the results of the sleep study because you have to make treatment decisions this summer, maybe they will get you in sooner. If they still tell you that you can't see the doctor in that time frame, insist that the doctor call you. Do you have a good relationship with the doctor? Is he/she in private practice? Remember, the squeaky wheel...

I've never heard of the weight gain due to tonsillectomy theory. Here's one explanation for it, though:

http://www.jpeds.com/article/S0022-3476 ... 9/abstract

Did you say your daughter's tonsils are large?

I think you are going to need a competent doctor to help you sort out whether the results of the sleep study suggest that a T&A (tonsillectomy & adenoidectomy) would help. Ideally this would be a pulmonologist who is also a sleep doctor. If your pulmonologist doesn't fit the bill, you may need to get a second opinion from another one who is a sleep doctor. Of course an ENT can weigh in, but most ENTs won't be able to speak to this hypoventilation/obstruction/etc issue. Are you near a large city? There ought to be more doctors to choose from. Maybe your sleep doc can recommend someone in pediatrics.

We are already on the cancellation list. My daughter's pulmonologist is the #1 in our state so it's practically impossible to get an appointment sooner with her.

Also that's part of why I'm confused! Her pulmonologist IS a sleep disorder doctor! So why are we being sent to a separate ENT?

At the last appointment she had with the pulmo she said that her tonsils were slightly enlarged but she wasn't sure if they weren't large enough to really cause any issues.

We are two hours from the city. We have to drive 1.5-2 hours to see specialists. We're in a pretty cut off small town.

On top of all this my husband is VERY anti surgery. He says unless they can look into her throat and say 'wow they are so huge that's for sure what is causing issues' he'd prefer the cpap over surgery (he had his out as a kid and almost died from bleeding issues)

I'm frustrated and being a mom is hard. I guess I'll just print out some of this information I'm finding for when we see the ENT on Tuesday. It seems like some ENT doctors are certified to treat sleep apnea from what I'm reading?

UGH.

Also I could see Failure to Thrive being a problem with sleep apnea but DD has had a few upper GI and swallow studies and has no problems with that either?

Also SleepingUgly if I sound frustrated please please know it's not at you! I'm just frustrated with being given results. Not being told they wanted to talk them over and being told 'She want's your daughter to see an ENT about getting her tonsils out' and that's all I get.

I did ask the nurse 'What if she's not a candidate for tonsil removal for whatever reason' and I was told 'Then we'll figure out what to do then'

*beats head into table*

SleepyonMagnoliaSt wrote:My daughter's pulmonologist is the #1 in our state so it's practically impossible to get an appointment sooner with her.

Then get her on the phone if you need an answer sooner than the appointment.

Also that's part of why I'm confused! Her pulmonologist IS a sleep disorder doctor! So why are we being sent to a separate ENT?

OK, good. Then the pulmonologist needs to explain the sleep study results to you. I assume the ENT is to help determine whether surgery would be beneficial.

At the last appointment she had with the pulmo she said that her tonsils were slightly enlarged but she wasn't sure if they weren't large enough to really cause any issues.

Yeah, been there... It would be an easier decision if her tonsils were huge.

On top of all this my husband is VERY anti surgery. He says unless they can look into her throat and say 'wow they are so huge that's for sure what is causing issues' he'd prefer the cpap over surgery (he had his out as a kid and almost died from bleeding issues)

Wow, you two have some terrible childhood experiences related to your mouths, huh?!

I'm frustrated and being a mom is hard.

Tell me about it... We saw two top sleep docs in pediatrics. One said our son had OSA. One said he did not. What does a parent do with THAT information?! Meanwhile, he did have a T&A for what we thought was SDB. I haven't lost any sleep over having done that even if he doesn't have OSA, but then again, I didn't lose any sleep about my decision to have a tonsillectomy myself for my SDB while in my 40's. Course if either of us had almost bled to death, I might feel differently about it!

It seems like some ENT doctors are certified to treat sleep apnea from what I'm reading?

There's nothing to stop an ENT from getting boarded in sleep medicine. I think many just say they specialize in "sleep apnea" because they see a lot of it.

I know I mentioned this to you before but once again, I'd add to your list of questions to ask the ENT whether they would recommend a total tonsillectomy over a partial given that you're doing it for airway reasons (assuming they would recommend a tonsillectomy at all)...

SleepyonMagnoliaSt wrote:Not being told they wanted to talk them over and being told 'She want's your daughter to see an ENT about getting her tonsils out' and that's all I get.

That's not right. The doctor needs to explain the results to you. Even if this were straightforward OSA with no other findings, at least a phone call explaining the results is merited before sending you off to the ENT.

I don't understand the hypoventilation and all the stuff about the asthma, etc. and how it relates to this diagnosis and how much that changes whether a tonsillectomy can be a cure or not. If it could be a cure, that's huge. I wouldn't/didn't want a CPAP mask on my developing child's face long-term if I could help it. But again, we didn't have negative experiences with tonsillectomies.