cardiology appointment today

Gabriel's heart is doing amazing!  The cardiologist kept talking about how last year after surgery he was sure he was going to have to send Gabriel back to the University of Michigan to have another heart surgery.  If i have not mentioned it before our cardiologist ROCKS.  He is a great man whom I completely trust.

While they were doing the echo the stumbled upon a completely different problem.  The pressure in Gabriel's lungs is higher than it should be in some places.  This suggests that Gabriel is having problems with sleep apnea.  Our cardiologist started to go through a list of symptoms... high lighted are symptoms Gabriel has.
Associated features of sleep apnea may include:

• snoring - loud, squeaky, raspy *more so lately, but we thought it was because he has a stuffy nose.
• nocturnal snorting, gasping, choking (may wake self up) *Gabriel is constantly waking himself up randomly at night with weird gasps. 
• restless sleep *my little man is always moving at night
• heavy irregular breathing
• excessive perspiring during sleep *He is a very warm sleeper just thought it was normal.
• severe bedwetting
• bad dreams (nightmares) *Poor little man wakes up crying and shaking on a regular basis
• night terrors
• sleeps with mouth open, causing a dry mouth upon awakening *Boog's mouth is always open when sleeping
• chest retraction during sleep in young children (chest pulls in)
• sleeps in strange positions (more on positions at bottom of list) *I have posted pictures of this
• confusion upon awakening
• unrefreshing sleep
• excessive daytime sleepiness
• may develop high blood pressure
• may be overweight or underweight *feeding issues
• excessive irritability
• change in personality
• failure to thrive or grow
• frequent upper respiratory infections
• hyperactive behavior 

Strange Sleep Positions Children will sometimes be in strange sleeping positions. Normally positions change many times during the night. It becomes abnormal when the position lasts too long. And even more important is that the parent tries to change the child's position, and the child will go right back to the same position. If the child is forced into another position, the child may awaken and be irritated.
some of the strange positions include what is called "get-ready" positions that increase muscle tone that makes it easier for the child to breathe. For example:

• The child places his or her head and arms against the headboad. the child looks as though he or she is stretching, but the muscles are very firm.
• The child is on his or her stomach with the head to one side on the pillow and is on his or her knees with their rear end up.
• The "upside-down" position involves the child extending their upper body over the side of the bed, looking as though they will fall on the floor. The child may stay in this position for a long period of time. If forced back onto the bed, the child may slide back into the same position.
• "Arched positions" involves the body being arched, like the child is standing on his or her head and feet.
• A position that is quite different from the ones described above, involves the muscles being totally relaxed. The child lays on his or her back, so quiet that it looks as though the child is "dead" and not breathing. These types of positions are typical of bedwetters before they urinate and of patients with sleep apnea before apnea develops. 

I wish I had known more of the signs.  The only thing I ever associated with sleep apnea is snoring.  I would have asked his ear, nose and throat doctor about it before now.  To fix sleep apnea in children doctors first remove the tonsils and adenoids.  Sleep apnea is found in about 46% of children with Down syndrome.  

So... depending on what the ear, nose and throat specialist says, we may have to be looking at another surgery for Gabriel.  It is too soon to tell but if he is having problems with sleep apnea it is important that we get his airway clear as soon as possible.