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Sleep Apnea Sleep Apnea occurs when a child actually stops breathing for a (usually) brief period of time. Apneas may last anywhere from 10 seconds to a minute or more. They may occur anywhere from one time to hundreds of times during the night. Sleep Apneas may or may not be accompanied by oxygen desaturation and bradycardias. Oxygen desaturation (known as a desat) is a temporary condition where the oxygen levels in the blood dip lower than their normal 97-100%. Desats vary widely. They could be as mild as 20 seconds at 87% saturation but they could also mean a minute at 50% saturation, a very dangerous condition when desats of this severity happen repeatedly throughout the night. Bradycardias are momentary stoppages of the heart beat. As with desats there is a range on how long these may last. A child can have sleep apneas without the accompaniment of desats and bradycardias but they are 2 important factors to simultaneously monitor during a sleep study. Obstructive vs. Central Sleep Apneas There are 2 types of apneas and a child may have either type or a combination of both. Obstructive Apneas occur when some structure of the mouth (tonsils, tongue, fatty tissue, low toned muscles...) obstruct the airway and lead to the momentary cessation of breathing. These are often treated by a surgery to remove the tonsils , reshape the tongue, or otherwise treat the offending structure. A CPAP machine may also be used to provide a continuous flow of oxygen through the night. Central Apneas occur when the message from the brain to the breathing muscles is sent incorrectly. The breathing muscles are literally not getting the message to 'breathe' correctly. These are believed to occur in the Thalamus area of the brain. Sleep Apneas and PWS According to Dr. Scott Steifel at the summer 2003 National Conference, sleep apneas may be occurring at a higher rate than previously believed in children with PWS. He recommends a sleep study during childhood to monitor the following factors : brain wave activity, respirations, sleep stage architecture and slow wave sleep. While a child may show outward signs of apneas (including but not limited to) restless sleep, snoring, frequent waking and behavior problems, there are not necessarily always outward signs that apneas are occurring. There have been a few deaths of children with PWS soon after starting Growth Hormone. While this is likely coincidental, new recommendations suggest that ruling out obstructive apneas and having a child's weight under control are two important factors for the safety and success of growth hormone treatment. An informative article regarding these recommendations has been provided by the National Association here: What actually happens during a sleep study? A sleep study is performed in a sleep clinic overnight. The parent can stay with the child during the study but the child must fall asleep in the clinic after being hooked up to many electrodes and monitors. You typically arrive in the early evening, usually around 7pm, hook up all the monitors and then help your child to fall asleep in the clinic. They may ask that the child skip their nap for the day so that they can fall asleep quickly for the study. Enough data may be collected by 3 or 4 in the morning so it is not always a full overnight experience. Many parents report that this experience is no problem for their young children especially if a few days ahead of time have been spent preparing the child for what is going to happen and how 'silly' it will be to have all of these wires being put on them. Take a special blanket or stuffed animal to provide some familiarity and double check ahead of time that you will be allowed to stay the entire time (I have not yet heard anyone say that this has been a problem). A Pulmonologist, Neurologist and ENT will read the study once it is complete to determine if/how many apneas are occurring and make recommendations from there. You should feel free to forward the study to any doctor you would like to have read it and give their input. If a Neurologist is not involved in the initial reading, ask that it be forwarded to your Neurologist, especially if central apneas are present. The more input the better if surgeries or medications are to be pursued. |