1046 Severe hypoventilation in a child with rapid onset weight gain

Abstract Introduction Pediatric sleep-related hypoventilation is a clinical pattern in which ventilatory insufficiency occurs the setting of either severe OSA (obstructive hypoventilation) or obesity (sleep related hypoventilation). We are reporting case describing management overlapping obstructive due to uncontrolled and pediatric syndrome. Report case(s) The patient full term African American 5 y/o male with past medical history prediabetes who was referred discuss sleep problems after rapid onset weight gain.He gained 76 lbs over 8-month period; during this time his aunt noticed apneic events development loud snoring.Initial workup negative for abnormal findings,MRI w/w/o unremarkable TSH, cortisol, GH, IGF-1 prolactin were all within normal limits. X-ray bone age study showed skeletal appropriate patient's chronologic age.Upper airway exam tonsillar hypertrophy 3+ Mallampati class 4.The diagnostic PSG demonstrated presence 12 obstructive, 151 central, 61 mixed apneas.There 214 hypopneas resulting an Apnea\Hypopnea Index 60.5 per hour.Mean oxygen saturation 91.3%.The lowest 64.0%.Time spent ≤88% 119.7 minutes (26.2%). End tidal CO2 range between 50-100 mmHg 30% study.The titration revealed that optimal treatment modality BiPAP ST. Conclusion This focuses on five-year-old experienced gain presented snoring, excessive daytime sleepiness found have profound hypopnea predominant apnea.The initial differential diagnosis includes ROHHAD, congenital central syndrome, primary apnea syndrome.The most common cause children remains OSA.The stepwise approach such tonsillectomy adenoidectomy,along use BiPAP. After T&A should repeat capnography, if hypercarbia persists post procedure PSG, he will need continue therapy loss program. Early recognition evaluation, population imperative prevent long-term consequences. Support (if any)