Thursday, April 14, 2011

Obstructive Sleep Apnea (OSA)

While in the hospital, I found that Wesley was having a really hard time breathing at times, and he sounded like he was snoring, though he wasn't really congested or anything like that.  I hadn't noticed it before, but I don't normally share a bed with him (not since coming home from UA anyway...).

Respiratory Therapy came in to check his airways, etc, and with a gentle 'adjustment' of his chin, he no longer snored or seemed to be struggling to breathe (his trachea area was 'pulling' when he was breathing, showing distress-like symptoms).

I am definitely not well informed about OSA, and was hoping some of you may be :).  It was recommended that we get a referral to ENT and have a sleep study done for him because he may need a cpap or bipap.  I know what they are, I know that they are to treat OSA, but what I am more curious about is whether this could be ONLY a result of the surgery (recent intubation and heavy pain meds causing 'extra' relaxation).

The last few nights he's woken up many times during the night, yet doesn't appear to be in pain during the day for the most part.  We have still given one or two doses of pain meds in the daytime (could be up to every 4 hours... but only 1 over 12 hours yesterday) but at night we've given it twice, and he's not even moving around, etc... he just wakes up in an inconsolable cry.  Since he can't communicate, we go ahead and give him the pain meds *in case* that's what's bothering him.  Within 20 minutes he usually calms down, but last night he was awake almost all night (even with pain meds) and fussing every 5-10 minutes until 4:30am when I finally just put him on my chest on the couch and he slept until 6am.  Unfortunately, I didn't sleep even during that time, so well, because there was a boy in a heavy cast leaving indentations on my arm, chest, and leg from laying on top of me LOL.

And so, the question is... could he be waking from OSA?  Could he have always snored an dus just not notice it? Could it be positioning since he used to sleep curled up on his side and now he is more on his back?  He DOES sleep on his side some but always moves back to his back during the night, even with propping right now.  Could it be just from surgery?  Should we go ahead and seek an ENT referral and go through a sleep study or is there "something else" we should be looking at before putting him through that?  Though I know it's painless, it's "just one more thing" for him, since he has an EEG (rescheduled from TODAY since he's still on pain meds) and sedated MRI coming up already and just had surgery...

Thoughts?  I WANT him to breathe well!  I just don't want to jump the gun and put him through a lot if this could all be circumstantial.  I will, of course, talk to the pediatrician about this all and probably mention it to our ENT next time I'm in even if we don't go that route... but thought I'd ask the "experts" too (YOU!).   Thanks!


  1. My daughter had pretty severe OSA and had to have an adenotonsillectomy to "fix" it at age 2 1/2. OSA left untreated can cause a myriad of other issues. If you want to you can email me at cameron_al@hotmail dot com for more info. I would definately agree with going to an ENT like you mentioned in your post.

  2. My son also had OSA, we took him to an ENT doc and his adenoids were removed about a week later. He hasn't had any issues since! I hope it's an "easy fix" such as this.



  3. I wrote about this on my blog.


  5. I am very familiar with OSA. All three of our boys had huge tonsils/adenoids and had them removed at age 3. That cleared it up for breathing well when sleeping. My husband also has OSA and wears a bipap.

    However, I think, if it's possible to watch him at night if you can and see if he is struggling to breathe. I am pretty sure that's the only way you will truly know. Sleep studies are invasive and we tried to avoid them when we could for our kids when they were little.

    I think being in the hospital could possibly have contributed to it as well. Only a Dr. can really tell and I know you will be in touch with him because you are one awesome Mama.

  6. I would follow up with Ent.My jax had his adenoids out hoping to help his apnea issue.He was scheduled for a sleepstudy but Jax had more severe things going on and ended up crashing and now has a trach.I adnoidectemy and tonsilectomy could possible cure the problem.

  7. My 6 year old had OSA and used to wet the bed every night and vomit at night approximately 2 times a week. He would vomit, then fall back to sleep after the cleanup was done. He had his adenoids and tonsils out in January and has never wet the bed or vomited since. Both were due to the sleep apnea according to the surgeon.

  8. I think you have a lot of good advice here! I myself am borderline for a CPAP machine. If I sleep on my back, I wake up constantly overnight because I start to snore and it wakes me up. Side sleeping helps. So maybe that is why Wesley is having a hard time, because he can't sleep on his side right now. Hugs and prayers for a quick resolution and a good night's sleep!!

  9. I do not have sleep apnea, and I do not generally snore. However, I have several medical conditions which necessitate fairly heavy pain and sleep medications at times. My husband says that when I have a higher than usual dose, or when I am taking dosages more frequently, that I snore extemely loudly. He is a pulmologist (although not a sleep therapist) and says that it even sounds like sleep apnea at times when I am heavily drugged. Not sure how this relates to a child with possible sleep apnea, but yes, I definitely think it could be exaggerated by the medication.

  10. I have OSA myself that is very positional. It could be a combination of pain meds and positioning as you said that's causing his obstruction. Sleep studies aren't a big deal, but as you said, it is one more thing for him to deal with, and if it's just circumstantial, I'd mention it to your Ped and get his/her opinion.

  11. What I can share is we had a sleep study done during a long hospital stay when Aidan had several surgeries/procedures, b/c they thought it might be OSA. In his case it turned out it was a combination of very bad reflux, which we learned from the ph probe, and the type of anesthesia used. In his case it was what you speculated in your post, basically the meds made him "too relaxed".
    If it were me I would wait a period to see what his "baseline" sleep/breathing pattern is like. It seems like there are so many variables right now. Maybe you could at least wait a time until the other sedated procedures are done? In our case we were told that with kids with CP, hypotonia or other myopathies they react differently to the most common types of anesthesia, so you might want to be sure that variable was out of the picture as the cause. Also Benadryl and certain sedatives seemed to produce these same issues for us.
    The best advice I ever got, (from our social worker!) was "when you pick your specialty, you pick your diagnosis". So, so true! In other words, can you be sure an ENT visit would be giving a complete picture?