The wait for the results of Nolan's most recent sleep study has been excruciating. Since breathing seems to be rather vital for growth and survival, it is an issue that frequently weighs on my mind. The results are a bit of a mixed bag- I'll start with the good news.
Nolan's central apnea has improved by quite a bit. In the first study, he had 60 central events with his oxygen plummeting to 79%. The apneas were about 10 seconds in length, which was troubling considering his apneas were so short.
In the most recent study, Nolan only had 10 central apneas. TEN. The lowest oxygen saturation was 90% (for 12 seconds), which is a considerable improvement! The length of the apneas was anywhere from 10-15 seconds.
And now the "bad" news:
Nolan's obstructive apnea in the first study consisted of 3 obstructive events and 41 hypopneas.
The current study shows that his obstructive apnea has actually gotten worse, post-tonsillectomy. He had 69 obstructive hypopneas. A normal Respiratory Disturbance Index (RDI) is <1.5 for children. Nolan's RDI is 11.5.
This is considered "moderate" obstructive sleep apnea for the pediatric age range, and is generally treated with C-PAP. Unfortunately, the neurologist noted that he has mild frontal bossing and a decent amount of midface hypoplasia. This means she's not very keen on the idea of a C-PAP mask on a still-developing face, when there is already an underdeveloped midface. The pressure of the mask could cause further problems with his still-growing bones.
Our treatment options are as follows:
Option 1: C-PAP. We could start C-PAP now and just watch Nolan's face carefully for any worsening of his hypoplastic mid-face area. The benefit is that it should solve the obstructive apnea and aid in any central apneas. The negative is the obvious issue with Nolan's facial structure.
Option 2: Medication. We could start Nolan on two different drugs (essentially steroids) to see if they help clear up the obstructive apnea. This is usually reserved for milder cases of obstructive apnea, but it remains an option. I'm not keen on this plan, for two reasons.
One is that all medications have side effects, and I don't know if the benefits outweigh the risks. The medications may not help, and the effects of the medications on a growing child concern me. The other reason I'm not keen on this plan is that we don't know why Nolan has obstructive apnea. He's not overweight (actually slightly underweight) and his tonsils were clearly not the cause of the apnea. Throwing him on more medications in the "hope" that it "might" help seems a tad rash to me.
Option 3: Watch and wait. We'll do nothing now, and follow-up with a sleep study in 6-12 months to see where things stand. Based on the information at that point, we'll make treatment decisions.
This is the option we chose. We'll do another sleep study in May, nine months from now. If the apneas (of either type) get any worse, we'll initiate C-PAP or BiPAP. If they stay the same, the likely solution is C-PAP or BiPAP. If they get much better, then I'm throwing a party and you're all invited!
We'll see what the ENT thinks of the latest round of information. Overall, the sleep study results are much better than the baseline study. We'll remain cautiously optimistic until we get the results from the May 2011 study!