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ASV after endurance sports
#1
Who from the community has to use an ASV-machine and has lived a life with endurance sports like running (marathon), swimming, rowing or cycling from his early years onwards. These sports would lead to bigger lung capacity than normal. I wonder if this circumstance could lead to having more central apneas than the average population.
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#2
I am an avid cyclist (many years under the wheels) and used to play underwater hockey (that one really works the lungs!). No ASV required here. I will note, though, that my resting respiration rate is naturally a little lower...but to be sub 6 resps/min is really, really low.

I've known lifelong cyclists, triathletes and ultra-marathoners...folks so fit that they have waking heart rates in the 40's...and although they have lower breathing rates than I do, they are still much higher than what would trigger an ASV.
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#3
An apnea is an apnea. To have an AHI of zero, there needs to be zero apneae. So anyone not having an AHI of zero is having at least one apnea per night.

But as some have said, the quality of sleep is the goal. And we reach the goal by not having the quantity or severity of apneae that arouse us and that desat our 02. Any of us still may have an occasional apnea.

Minimizing them for those who score more than 5 is the goal of xPAP, and reaching less than 5 apneae per hour meets that goal. So, that also is the definition of normal sleep, as well as the absence of OSA. If you have less than 5, that means you are normal. If you have less than 5 with xPAP, that means that you are treated fully and successfully.

All things are on a scale; the only thing that is absolute is the ones and zeroes of digital encoding, and sometimes that is not fully black and white either. All medical decisions are made as a weighing of options. Every doc weighs the pros and cons for every diagnosis and course of action. Insurance may have other motivations, but they, for the most part, follow this same model. These decisions are not about whether you absolutely have no events, they are about where you fall on the scale, because virtually everybody falls on the scale, and not at either end of the scale.

If you have a sleep study and have 0 AHI, that is only representative of just a few hours. And it indicates that someone really guessed wrong about needing to determine whether you have OSA or not. That probably rarely ever happens.

Normal is always a value judgment made on a call of where something lies on a scale. There are very few absolutes anywhere, and even fewer in medicine and in conditions like OSA.

But having an occasional apnea does not define one as having OSA, because having an occasional apnea is normal. Respiration is exceptionally complex, and probably never perfect.
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