Ask Dr. Gwenn

Does My Child Have Sleep Apnea?

January 2007

Q) Dear Dr. Gwenn:

My 29 month old son was referred to ENT for sleep apnea due to his snoring.  He had a sleep study that showed his O2 levels to be low, but not enough to warrant a tonsillectomy.

However, his resting pulse rate through the night set off the monitor alarm for dropping below 56, should we be worried and push for a further consultation?

Thanks!

RH

A) Dear RH:

Thank you for your question. Issues of second opinion have a way of developing in situations like this. Monitors sometimes create more problems then they solve. Let me give you some background on some of the details to help you make an informed decision about what is best for your son. For more information on second opionion considerations, see my column on this topic.

There are a number of issues to consider. First, the diagnosis of sleep apnea in children is more clinical than test-dependent.  Interpreting sleep studies in kids is not easy and there is no clear consensus on criteria for those studies. So, if your child is snoring and has behavioral changes the next day, or is exhausted during the day, likely your child has sleep apnea that requires intervention with a tonsillectomy. However, if your child has no daytime symptoms, the surgery is likely unnecessary.  The ENT you consulted seems to be focusing on the test results, not the big picture.  Talk to your pediatrician and if you are still not comfortable a second ENT consult with a pediatric ENT may be helpful.

Second, interpreting oxygen saturation and heart rate is difficult in kids because the probes don’t always pick up accurately. Any movement can produce a false alarm that a low number is present when in fact it is just that the probe can not read the data accurately. The big picture is more important than any one isolated number.

The ENT literature does support the diagnosis of sleep apnea clinically and also highlights the need to not over read the sleep studies due to how inaccurate they can be in kids. Here’s some links for more information on the diagnosis of sleep apnea and current thinking:

Sleep Apnea and Performance During The Day

Interpreting Sleep Studies During Sleep Apnea Evaluations

What is sleep apnea?

Finally, as my prior column highlights, the reasons for a second opinion are two fold:

1. you are not comfortable with the initial advice
2. your son has daytime symptoms that imply his sleep is disturbed at night.  

I find parents have a very fine tuned sixth sense when it comes to their kids. Trust that sense and pursue this a little more.

Best,

Dr. Gwenn