Pale even when awake
On August 13, information from the Respiratory Department - Children's Hospital 1 said that the unit had received patient N (4 years old, Ho Chi Minh City) in a state of clear purple lips, SpO2 index reduced to only 80 - 82% when breathing fresh air, accompanied by lethargy. The child weighed up to 22kg - an abnormal weight compared to age.
According to the family, since being over 2 years old, baby N has snorted loudly and experienced sleep apnea attacks. The child was diagnosed with sleep apnea syndrome due to tonsils and VA hypertrophy, and underwent tonsil removal surgery and VA incision.
However, only about 1 month later, there was a slight improvement, the symptoms relapsed and became more and more severe. The child developed shortness of breath during the day, headache in the morning, and prolonged cyanosis attacks. About 3 months before being hospitalized, the baby started to become cyanosis even when awake.
At the Children's Sleep Unit - Department of Respiratory Medicine, the results of multiple sleep monitoring showed that the apnea - decreased breathing index of the patient was up to 39.5 times/hour, the lowest SpO2 in the night dropped to 61% - the level of apnea due to severe obstruction.
Notably, arterial blood gas tests detected increased amounts of CO2 accumulated in the blood. The child was diagnosed to have progressed to obstetric hypoventilation syndrome (OHS) - a condition in which the body loses the ability to excrete CO2 even during the day.
Conducting endoscopic airway techniques using anesthesia (DISE), doctors discovered that the child's pharyngeal muscles were severely weak, causing the airway to collapse more than 75% when sleeping. This is the reason why the previous tonsil removal and VA aspiration surgery was not completely effective.
Multidisciplinary coordination to treat pediatric patients
Before the very complicated case, the hospital mobilized a multi-specialized department. The Ear, Nose and Throat Department assessed the VA condition of the throat and lymphatic tissue proliferation, advising that no additional surgical intervention was needed because the main cause was pharyngeal tone deficiency.
The Department of Nephrology - Endocrinology excludes secondary causes of pathological obesity. The Department of Nutrition establishes a specific diet to support long-term weight loss.
The Department of Odonto-Stomatology assesses the structure of the skull and face, the design of active oral devices helps to pull the jaw and tongue forward, expanding the airway space when sleeping.
The Department of Respiratory Medicine prescribes non-invasive 2-level positive pressure ventilation (BiPAP) ventilators for children, and at the same time, guides families with tongue and pharyngeal muscle exercises at home to improve respiratory muscle tone.
Only after 1 month of treatment and re-examination, the patient's health improved positively. Baby N was rosy, fresh, completely no longer purple when awake. At night, the child slept peacefully, lying on their back all night without moving or writhing.
MSc.BSCKII Ho Thien Huong - Deputy Head of Respiratory Department, Children's Hospital 1 said that according to medical literature, obstructive sleep apnea syndrome (OSA) in children often responds well to tonsillectomy and VA removal surgery. However, in severe obese children, the pharyngeal muscle is weak, causing the airway to still collapse when sleeping even after surgery.
When OSA is prolonged, chronic CO2 accumulation reduces the sensitivity of the respiratory center, causing the body to not respond properly to oxygen deficiency, leading to obstetric hypoventilation syndrome (OHS). This condition is rare in children, easily confused with chronic lung diseases, so it is often diagnosed late.
Successful treatment requires multidisciplinary coordination and in-depth diagnosis of sleep.
