Sleep Study

*These images look much worse than they appear: Eli was in no pain, just loads of wires. Mama’s, if you have ever wondered about OSA, look into it. I’m so thankful we did*

This Wednesday we had our sleep study. I was prepared for it to be rough, but I was particularly stressed and had a very high anxiety level prior to even arriving at the hospital.
The traffic was awful (thanks I-10, Katy Freeway!!) and by the time we arrived Eli was crying from having been in the car for so long. I got us loaded up (the stroller was so packed, I looked like a homeless person) and we headed to the entrance…only to be locked out because we were late.
So I had to load back up and move to the main entrance and start all over. -_-
Upon arrival we were allowed to do all our normal bedtime activities. I was able to relax a bit.
I was informed that the room as visually and sound recorded so everything I did/said was on tape. Sweet.

They came in to hook up Eli while he was drowsy and ready for bed. But by the time they began he was alight with wonder and excitement…ooooh wires and colored stuff I’m not supposed to touch. Sweet lol
Once the hooked him up (he handled it very well, never fussed…28 wires all over his head), they told me to put him to bed. Yeah right. lol

Once he finally did pass out, I was left in a pitch black room unable to talk, make noise or have any lights on. So I entertained myself in the dark with Facebook…until the nurse started coming in.
She did A LOT of checks. She would fuss with him, adjust wires and mess with things until he would start to wake up. Then she would shut the lights off, and leave. Within 5-6 minutes she would return and repeat the process all over. This went on all night.

When the nurse wasn’t constantly coming in, Eli would start to fuss. So I would get up, comfort him and get him back to sleep, only for the nurse to come back in and fuss with his wires and wake him back up. It was terrible. I think I ran on 2 hours of sleep all night. Fun.

By the end of the night, he was fussy and ready to be detatched from the wires. He had started to get snotty (he goes down clear and wakes up with a stuffy nose…turns out it was a yeast infection in his nose. nice) He woke up around 5:30 but the test wasn’t over until 6 so we just hung out in the crib until the nurse came back into the room. He was in good spirits and smiling through the majority of the process. 🙂 And I got to spend the rest of the following day playing with him and snuggling. It was so so nice and I treasure those moments.

____________________________________________________________________________

Final diagnosis:
Mild obstructive sleep apnea
Sleep Apnea
DS and OSA
More on DS and OSA

Study results:
The patient was evaluated during a 9 hour and 32 minute nocturnal session beginning at 20:30 hours. This was a standard polysomnogram.
The patient was put to bed and the lights were turned out at 20:30 hours. After 12.5 minutes the patient fell asleep achieving a period of non-REM sleep. The total sleep time was 7.9 hours accounting for 82.8% of the monitoring time (expected values greater than 90%). Both REM and NREM sleep characteristics were recorded. The sleep stage distribution was typical for age with 26.5% stage REM sleep recorded (expected range 18-25%).
During the study there were 17.7 arousals per hour of sleep (significant values greater than 14 per hour of sleep). Sleep disordered breathing was associated with 5.7 arousals per hour of sleep. Periodic limb movements were associated with 0 arousals per hour of sleep.

The patient was recorded while sleeping on the back, stomach and sides. Snoring was recorded. During wakefulness the respiratory rate was 30-32 breaths per minute. During sleep the respiratory rate was 30-34 breaths per minute. The baseline oxygen saturation was 96%. The oxygen nadir was 90% (with obstructive hypopnea during REM sleep). The patient spent 0% of the total sleep time with oxygen saturation level less than 90%. The end tidal pCO2 values were elevated to as high as 50 mmHg. During 0% of the monitoring time end tidal pCO2 values were elevated above 50 mmHg (significant values > 25%).

During sleep 1 obstructive apneas, 0 mixed apneas, 9 central apneas (1-10 seconds), 26 obstructive hypopneas, and 25 RERAs were recorded. The apnea hypopnea index was 4.6. The respiratory disturbance index was 7.7 (6.6 obstructive respiratory events per hour of sleep). Respiratory events were recorded more frequently during REM sleep.

The heart rate was typically in the range of 103-133 beats per minute. No significant cardiac arrhythmias were recorded. During sleep there were 0 periodic limb movements recorded (0 per hour of sleep; significant values greater than 5.0 per hour of sleep). The occipital dominant rhythm was 6 Hz. There were no focal or lateral ozone features. No epileptiform abnormalities were recorded.

This patient has mild obstructive sleep apnea characterized by snoring and 6.6 obstructive respiratory events per hour of sleep that occurred more frequently during REM sleep. These events are associated with an oxygen nadir of 90% and end tidal CO2 values to as high as 50 mmHg. The events contribute to sleep fragmentation.

Recommendations:
– evaluation for upper airway obstruction including nasal congestion is recommended.
– if this patient is not a surgical or medical therapy candidate and the patient exhibits significant daytime symptoms thought to be contributed by sleep disordered breathing then the patient may return for a CPAP titration study although compliance in this age group would be difficult.
– the study may be repeated in 6-12 months if clinically indicated.

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So it all seemed a bit overwhelming to read and look over at first. I think I read the report 10 times. And after talking with the doctor and doing some google research, it seems like mild OSA cases are not typically treated (especially in Eli’s age group) with any kind of breathing intervention. His tonsils and adenoids are not large enough to warrent surgery or even be the cause of his OSA (a non-surgical option would be sleep positioning on his back, which was nearly impossible to do during the study due to all the wires).

All of his ranges were within normal or just out of the normal range. Overall, it seems seems the OSA diagnosis may be due to floppy airway, smaller facial structure and congestion.

It’s still alarming to say that he is OSA but I’m so glad to know. The good news is that as he grows we can test again and look into treatment if necessary. It also changes his treatment plan for future surgeries or sedation- this is a very very good thing to know about in advance.
AND Eli has grown large enough to have tubes put in!! Surgery is on the 20th. I am so thrilled about this last development. He *still* has fluid behind his ears and it’s definitely contributing to his congestion. Surgery makes me instantly nervous, but this will improve his quality of life and hopefully reduce the number of infections he gets.

I still have some questions for his audiologist on Monday, but for now I am just rejoicing in the fact that this week is over. It was crazy, it was rough, but it’s over and we are more educated as a result.

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