Persistent Pediatric OSA post surgeries; Pediatric CPAP?
Hello!
Has anyone’s child ever had an Adenotonsillectomy and Turbinate reduction YET still had unresolved Obstructive Sleep Apnea?
- After more than a year of night terrors, my 6 y.o. daughter was diagnosed with severe sleep apnea. She got a Partial Tonsillectomy and an Adenoidectomy. That brought her apnea down to a moderate level.
- But since the T+A surgery didn’t completely cure it, she then got a Turbinate Reduction. The turbinates were waxing and waning in size - at one point touching the septum. - Unfortunately, the turbinate reduction didn’t help and the AHI is actually higher now. She still has moderate sleep apnea, has incredibly restless sleep, has daytime fatigue, and has occasional night terrors. - She has tried Flonase to shrink whatever it is may be big in there, but that didn’t do anything either.- She’s not allergic to anything besides dust mites/mold. We constantly wash her mite-resistant sheets. - Both her dad and I have sleep apnea. :(
At this point I’m feeling like I’m running out of options. She’s not overweight (she’s slender, actually), does not have an oversized tongue, nor does not have a obvious small jaw or disproportionate jaw. I am very worried about the cumulative effects of apnea on her cardiovascular health, brain health, general health, etc. *Has anyone experienced something similar with your children? If so, what subsequent treatment did they receive, and did they work?* Has anyone’s children used a pediatric CPAP? If so, how long did they use it for, and did it affect their facial skeleton growth over time? (I have been told that CPAP on children may impede on facial growth). Did the Cpap work? Thank you so much in advance for any feedback!
Parent Replies
You might consult a dentist or orthodontist about her bite/jaw alignment. They often start at early ages now with retainers that can address a number of issues. Also, my cousin's child had a bad drooling problem. Finally, they learned that there was something wrong with how her tongue is attached. She was able to correct it through exercises. I just mention this because the tongue is involved in obstructive apnea.
She may need a sleep endoscopy to better diagnose where the obstruction is occurring - it's called a DISE (drug induced sleep endoscopy) and it does mean more anesthesia, but it is brief and yields concrete information as the surgeon directly visualizes with their scope where the obstruction is happening in the airway, while she's asleep. If it is operable, they can do it then (such as a lingual tonsillectomy, if the lingual tonsils are obstructing - lingual tonsils are not removed in a traditional tonsillectomy). I recommend Pediatric OHNS (Otolaryngology Head and Neck Surgery, formerly known as "ENT") at UCSF Benioff Children's Hospital in San Francisco (Drs. Rosbe, Meyer, or Chan). See what they think. From the medical perspective - have you tried Singulair at bedtime yet? You said Flonase hasn't done much, but there is data that Singulair (a leukotriene modifier) can help OSA. Or at least try Zyrtec - that data is less strong, but she should try an antihistamine of some sort, especially if you know she has dust mites/mold allergies. Lastly, you could also see a Craniofacial plastic surgeon (Dr. Hoffman or Pomerantz, also UCSF) to see what they think about her anatomy and how it may be contributing. Best of luck!