More Sleep Apnea Questions - Update

[BayGirl2]

Update: We saw the Ped last week for DD and she took a look at DS's tonsils - they were HUGE, almost touching each other. She gave us a referral to the ENT/Head-Neck Surgeon and we have an appt. this Thurs. We haven't heard him stop breathing besides that once but he does snore at night and at nap. His voice sounds "off" too, if that makes sense, like he has a sore throat. He doesn't say anything hurts though. I think I'll leave my phone in there recording tonight and try to catch the noises. We've been checking his throat daily and its still very swollen. He's sleepy and cranky too, although that may be age-and-sibling-related.

So we're a bit freaked out at the idea of surgery. He's so little and that seems so scary!! What other options are there? Can we take a wait and see approach or are there other treatments to try first? Obviously these are questions for the Specialist but I want to go in prepared. Any good sources of research for this?
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I saw the recent thread on Sleep Apnea but have some more questions for those of you who have dealt with it. DS is 2.5yo and otherwise totally healthy. But he seems tired in the morning regardless of napping or bedtime, and he snores if he sleeps upright in a chair or carseat. DH says he's heard him stop breathing so we're concerned about apnea. He hasn't been sick much, only on aBx once, no ear or throat infections. He's growing taller but has not gained weight in 8 months despite eating well, but we figure he has DH's metabolism.

I just emailed our Ped to ask if I should bring him in to be looked at. (He'll be with me anyway when I bring the baby in next week.) Any tips on what to ask her and say? I like my Ped a lot and she'd need to refer us for any specialists. Or tell me we're overeacting and these are probably not symptoms?

[hollybloom24]

If your husband actually witnessed your child stop breathing, you should demand a sleep study. I can't imagine any MD would disagree with that.

[rlu]

My DH's ENT ordered the sleep study. I don't know if a ped can order a sleep study. You might ask your ped to refer you to an ENT (ear, nose, throat).

We're local to you. DH's ENT is in Mountain View and it appears she does accept pediatric patients, however, your ped might already have an ENT she thinks works really well with kids.

The sleep study DH took was at a facility - I don't know how the sleep study for kids works. Several parents on this board have experience with sleep apnea in kids, so hopefully they can chime in regarding their kids' sleep study experience.

eta: if you can, try taping DS while sleeping so your ped can hear the snoring and possible stoppage. DH's symptoms included fatigue (and accompanying irritability), frequent and prolonged illnesses & falling asleep during tv or while at rest. He also put on weight but I'm not sure if that is a stereotypical symptom (certainly can contribute to severity of apnea).

[Simon]

This sounds a lot like Ds1. Not sick very often at all, only one ear infection ever and not until he was 3yo. BUT, he was tired and needed many, many hours of sleep but had great difficulty staying asleep, he woke often, snored in his car seat, and Dh and I had both heard him "pause" in his breathing while he was asleep. He was not ever a mouth breather (though that is another symptom).

We described all the symptoms to our ped who sent us straight to the ENT (she had BTDT with her own son). The ENT asked us about sleep, snoring, breathing, and whether Ds's voice was always so "nasal" sounding. It sounded normal to us, but if you compare video pre/post-surgery the difference is incredible.

We ended up skipping the sleep study; the ENT said that based on our reports and his physical exam of Ds1's tonsils, he would reccomend that at least the tonsils be removed. Well, actually he gave us options of trying meds and steroids to shrink them and the adenoids first. But, we all agreed that Ds1 sounded like a pretty severe case and Dh/I didn't want to try the sprays first. So, the ENT volunteered that we could skip some of the diagnostic testing (if we were comfortable) and that while Ds1 was sedated for his tonsil surgery, he would inspect the adenoids (no way to see them w/out a scope procedure otherwise, which required some mild sedation or numbing at least) and would either remove or leave them alone depending on whether they appeared to be obstructing Ds1's airway. We felt comfortable with this and liked that it could all be done at once, or not. ENT came back from the surgery and told us the adenoids covered 80-90% of Ds1's airway so he did take them out. We were relieved and glad we went ahead with it.

It took a few weeks for Ds1 to fully recover (most reports I read said a very fast recovery but that was not our experience) although his breathing improved immediately--snoring was gone, etc.. Within 2-3 months after the surgery, his sleep was vastly improved and he wasn't exactly a "new kid" but we could really tell a difference.

I learned about tonsil/adenoid problems and surgery thanks to the BBB. I would never otherwise have even thought to talk about these symptoms (all together) to our ped. Ds1 was just over 4yo before we caught this and I wish we had known sooner.

[amldaley]

He also put on weight but I'm not sure if that is a stereotypical symptom (certainly can contribute to severity of apnea).
In adults, yes, that is a symptom.

[amldaley]

I agree that you need to try to record DS's sleep sounds. A little digital recorder is pretty cheap these days.

Also, you can video with your cell camera.

I would def. ask about it but minor apnea is common in infants and some toddlers. And snoring in the carseat is common b/c kids flop over in to awkward positions. This is a good example of another benefit to having the car seat with a slight recline vs totally upright.

That said, with what your son is experiencing, I would ask for a referral to an ENT b/c it could be apnea, but as pp said, it could be tonsils or even something else. Not enough clear cut symptoms to tell really. How is his cognitive development? How is his mood?

[BayGirl2]

Thanks everyone. I was wondering if a little minor apnea may be normal at this age or if its definitely an indicator of a problem. We watch him on a video monitor at night but I like the idea of trying to record whats going on for the Ped. I'll try to do that before we see her. His carseat is a RF Blvd so he seems slightly reclined for a kid that age, and the times I've caught him asleep in a chair (this was during vacation) he was semi-reclined. So not an upright, head's tilting forward kind of thing.

His cognitive development has always been on track or a bit ahead of average. His mood is generally good, given that he's 2.5 and has the usual 2 year old "I'll do it myself" trials, but he is not a kid who has major tantrums. We have noticed him being extra sleepy lately, and that sometimes affects his mood.

RLU - thanks for the info. We're with Kaiser so will see our Ped first and I'm sure they have ENT's and sleep specialists within the system. I've had good experiences with referrals for even the most minor issues. They may even have programs around this issue in addition to specialists. I need to do a bit more research, but wanted to get a feel if we are just overreacting.

[BayGirl2]

Updated in OP