A Sigh of Relief

Yesterday there was an email in my in box that read something like this: "You have a message from Dr. Pulmonology. Please sign in to your account."

I knew exactly what was going to be in that email...Nathan's sleep study results. I really didn't know if I wanted to open it or just call Dr. Pulmonology to interpret the results because I don't like getting bad news in an email without having the doctor available for me to ask questions like; how bad is it?, does it require surgery?, how long will he be under?, are there other issues we should look for?, will this be life long?, and so on.

However, I mustered up the courage and opened the email. This is what it said:

Respiration: Average respiratory rate was 22 per minute. There
were a total of 0 obstructive apneas, 1 central apneas, 0 mixed
apneas, and 1 hypopneas. The overall apnea-hypopnea index (AHI),
therefore, was 2 events/hour. REM AHI 0.2 events/hr. The
respiratory disturbance index (RDI) which includes the AHI and
RERA index is 0.2. The mean oxygen saturation while awake was
98% and during sleep was 97%. The minimum oxygen saturation was
92%. There were 36 desaturations >3% for an index of 4.3/hour.

Did you see that? ZERO obstructive apneas, ONE Central apnea, and his oxygen stayed at an average of 97-98% with a less than 3% destaturation rate for the night!

Here is Dr. Pulmonology's impression:

The sleep
latency was normal. Sleep stage distribution was normal. Sleep
efficiency was normal. No snoring was heard. The patient had a
normal number of apneas. Nathan does not meet criteria for
significant obstructive sleep apnea. Nasal airflow sensing was
limited during this study and it is possible that more subtle
events were not detected. The patient did not exhibit any
snoring, which is consistent with absent OSA.

Let's rewind a little:

Nathan's last sleep study showed approximately 45 apnea episodes AN HOUR with his oxygen getting down in the low 80's. As a result of his last sleep study it was recommended that his tonsils and adenoids be removed even though he was so young (we were told that removing them before the age of three can cause bleeding problems during surgery and they could possibly grow back). However, he ENT surgeon felt Nathan's apnea was so bad that the need to have it done outweighed the risk.

We were against having his adenoids removed because we suspected that Nathan had a submucous cleft palate and had read that the adenoids support the submucous cleft palate and prevent it from sagging, leading to other feeding, speech, and sinus problems (which he didn't need to add those to his list of challenges).

So, surgery was done during early Fall of last year. The surgeon came out and said that he had to take Nathan's adenoids out because if he didn't, we would be back for surgery within the year because his airway was so small and they were taking up airway space, contributing to his apnea and swallowing problems. He said that we could deal with the feeding, speech, and sinus issues as they showed up, if they showed up, in only a way that a surgeon can do.

Fast forward to today:

Nathan's swallowing issues, as far as textures go, have greatly improved. He did have a little sinus problem, but allergy medication took care of it 100%. And...the boy is nonverbal at this point so it is too early to tell if it is going to effect his speech.

But...the big one is that he is apnea free! I'm sure we will have to continue to check it periodically throughout his life because his anatomy will change. But for now, we will muster up the courage to put his pulse oximeter away and only use it only when he is sick. We have hooked him up to this every night since he was brought home from his first surgery at three months old to monitor his oxygen and heart beat.

So a big sigh of relief is being taken around the Oliver home. We are elated to mark this one off his list of diagnosis for the time being!

On a side note this was documented in the study:

The patient had a moderately elevated number of periodic limb
movements. The majority was not associated with arousals.
Periodic limb movements can be associated with iron deficiency,
sleep disordered breathing or exist independently.

We knew he moved a lot during the night! This one will be an easy fix...I hope!