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How bad is this? Is an adenotonsilectomy *truly* enough to reduce both obstructive AND central sleep apnea?

August 26th, 2012

This is for an overweight (30 bmi) teenager, who one year before weighed less than 80 pounds. (One last question: couldn’t losing weight fix the problem?)
Here’s a synopsis of the report:
Respiratory:
Total central apneas: 89
Total hypopneas: 98
Mean duration of apneas: 8.1 seconds
Longest apnea: 14.6 seconds

Apnea-Hypopnea Index (AHI): 27.5 events/hour
AHI during stage REM sleep: 33.5 events/hour
AHI in the supine position: 66.5 events/hour

Oxygenation: (I *think* all this part is good … right? wrong?)
Mean SpO2: 95%
Time spent with saturations less than 88%: 0.6% of total sleep time.
End tidal CO2 showed no significant hypoventilation.

Conclusions:
1) Patient had evidence of severe central sleep apnea, with an AHI of 27.5 events/hour an an SpO2 nadir of 80%
2) The patient’s sleep-disordered breathing was slightly wore in stage REM sleep and significanty worse in the supine positition.
3) The patient had abnormal sleep architecture.
RECOMMENDATIONS
1) Consider adenotonsillectomy to treat the obstructive component
2) Follow-up 6-8 weeks post surgery to assess clinical response
3) Consider MRI of brain and brain stem if central apneas persist
(*I DON’T GET WHY THEY WOULDN’T AUTOMATICALLY STILL GET MRI DONE. ANY IDEA?)

I would love to hear other people’s thoughts here on this. This is very new to me Funny thing is, I didn’t think the study was going to reveal much, so to hear all this is very confusing. Please feel free to give me your thoughts and suggestions. Thank you!

An adenotonsilectomy will do nothing for central sleep apnea. Central sleep apnea is when you repeatedly stop breathing during sleep because the brain temporarily stops sending signals to the muscles that control breathing. So there is nothing blocking or obstructing the airway.

Some types of central sleep apnea are treated with drugs that stimulate breathing. Patients should avoid the use of any sedative medications. If central sleep apnea is due to heart failure, the goal is to treat the heart failure itself.

MRI: The doctor reading the study would not "order" you to get an MRI because an MRI can be really expensive. If he ordered you to do it and it came up negative or inconclusive, you could file a lawsuit to have him (the ordering doctor) to pay for it because he told you to get an unnecessary test. So doctors use language like "consider" or "recommend".

2 Responses

  1. Matt A Says:

    An adenotonsilectomy will do nothing for central sleep apnea. Central sleep apnea is when you repeatedly stop breathing during sleep because the brain temporarily stops sending signals to the muscles that control breathing. So there is nothing blocking or obstructing the airway.

    Some types of central sleep apnea are treated with drugs that stimulate breathing. Patients should avoid the use of any sedative medications. If central sleep apnea is due to heart failure, the goal is to treat the heart failure itself.

    MRI: The doctor reading the study would not "order" you to get an MRI because an MRI can be really expensive. If he ordered you to do it and it came up negative or inconclusive, you could file a lawsuit to have him (the ordering doctor) to pay for it because he told you to get an unnecessary test. So doctors use language like "consider" or "recommend".
    References :
    Respiratory therapist

  2. sleep apnea Says:

    Thanks for sharing your thoughts on central sleep apnea. Regards

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