HARD DECISION Obstructive sleep aponea

[parrot]

My daughter recentley had a sleep study. Her oxygen levels were between 94% and 92% dropping ocasionaly to 87%. Adenoids (adenoids) have been removed.Do you think this is very seriouse and warrant a tracheostomy. Thank you very much.

[National Jewish]

Obstructive sleep apnea is a condition in which the airway does not fully open during sleep.  This causes breathing to stop temporarily while sleeping for up to a minute at a time.  This may happen several hundred times a night.  Each time this happens it is an episode of apnea.  This could cause your daughter to feel quite sleepy during the day.  It is possible that she is aware of this because she wakes herself up gasping for air.  It is more common that the spouse notices first.  Snoring is what often alerts people to the problem.

A nighttime fall in oxygen level to 87% is low.  The obstructive sleep apnea needs to be treated.  You did not mention your daughter’s age.  In babies it is likely for enlarged tonsils and/or adenoids (adenoids) to be a cause of obstructive sleep apnea.  If her adenoids (adenoids) were removed after the sleep study this may have taken care of her problem.

The most common and effective treatment is to use a continuous positive airway pressure (CPAP) device during sleep.  This is a machine that delivers air pressure into the lungs to keep the airways open while sleeping.  Your daughter may also need oxygen through the CPAP device.  Surgery for obstructive sleep apnea should be considered a last resort, only after a vigorous trial of (CPAP) has failed.  It is very rare that a tracheostomy is needed for obstructive sleep apnea.  Please read our Obstructive Sleep Apnea MedFact at http://www.nationaljewish.org/medfacts/sleep_apnea_treating.html for more information.

[AndyRRT]

Absolutely not. Obstructive sleep apnea is not an indication for a tracheostomy tube. There are other modalities such as mask CPAP that can help her with her breathing at night.

Was the idea of a tracheostomy yours or her physicians? Can you give me alittle more history on your daughter? What warented the sleep study and why were her adenoids (adenoids) removed.

Andy, RRT, CPFT

[parrot]

Hi, my daughter caitlin has Downs syndrome, she has been diagnosed with obstructive sleep aponea, obstructive and central episodes. She is very difficult and the hospital has only managed one heart scan a year ago because she becomes very distressed. They say the right side of her heart was starting to work harder. We tried the cpap machine on her two years ago and she refused to tolerate it. A few months ago her adenoids (adenoids) were removed for the second time. I thought I saw a good improvement at night. We went for a sleep study a week ago she fought attatching the machines and we were only able to get a two hour reading of one probe on her toe. Her sats were between 94 to 92 sometimes dropping to 87. The consultant told me if she dosent get a trachi she will die in a few years from heart disease. I asked what he would do , he told me nothing due to her intolerance of change. He refuses to give me the cpap another go as he says she wont tolerate it and it can be dangerouse if not used properley. Oxygen was also ruled out as I was told in some cases it can cause sudden death. I dont know what to do her, are her sats really so low?
Thank you Ann.