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Can an APAP replicate a Home Sleep Test?
#1
Can an APAP replicate a Home Sleep Test?
I am curious to know how the original apnea findings derived from the Home Sleep Test can be replicated using my AirSense 10 Autoset and a CMS50F pulse-oximeter. My kit includes an AirFit N20 nasal mask and an AirTouch F20 face mask. The one sensor in the Home Sleep Test which I lack is the chest strap. What settings would I have to use to best approximate the Home Sleep Test? 

Since I may be barking up the wrong tree, let me tell you what I'm curious about: I originally thought that CPAP addressed sleep apnea due to obstructive events, only to find included in the AHI index the central, hypopnea and unclassified events. Were these non-obstructive events also included among the 48/h apnea events (and 85% SpO2's) used to justify my Rx? I ask this because under the best conditions, using the nasal mask, I have less than 5 obstructive events but 23 unclassified events per hour. The unclassified events occur during periods of Large Leaks that occupy 40% of the session and I'm sure are associated with mouth exhalation. A taped mouth hasn't helped. I have yet to see SpO2 dips < 90%.
 
Am I correct to dismiss the significance of unclassified events? I should add that after 1 month of fiddling, I am finally able to sleep under the mask and have sessions lasting over 6 hours. Not only that, I feel better during the day! But I remain apprehensive over those huge AHI's and am pestered by the MyAir gremlin to fix the leaks!
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#2
RE: Can an APAP replicate a Home Sleep Test?
The apnea puzzle is that to treat, events need defined both in count and type. A CPAP can make an educated guess to what the person attached to the mask is dealing with. If you were to run the CPAP at straight 4 and no other settings regarding pressures you may see the best guess of apnea by the CPAP.

Unclassified events? I'd not dismiss as insignificant, but I'd question a bit the accuracy if there's larger leak rates as it sounds. And it sounds that large leaks is the biggest issue as it's presented. OSCAR is available that's far more accurate than the MyAir app. I'd use that in complete replacement of MyAir.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Can an APAP replicate a Home Sleep Test?
It is not uncommon for us to see what we believe is a incorrect diagnosis on a sleep test. This occurs because it appears that sleep labs provide nearly 99.999% of the time a diagnosis of OSA no matter what the percentage of centrals are present. Even 100% Central Apneas are diagnosed as OSA.

Post a redacted, we don't need your name and address, full copy of your sleep tests and we will tell you what we see
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#4
RE: Can an APAP replicate a Home Sleep Test?
Post a redacted copy of your sleep study. You can request a written copy of the report if you don't already have it for your records.
MacBookPro Catalina, Windows 10 (Parallels 16), FlashAir 16GB W-04, FlashPAP,
Contec CMS50F Pulse Oximeter (08/2020), Hardware v2.0.0, Software v2.0.5, 
Smart Device Assistant 3.1.0.1
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#5
RE: Can an APAP replicate a Home Sleep Test?
Just to summarize:

* Post a copy of your redacted sleep report. If you don't have one, get one. In the U.S., you have a legal right to have one.

* You can't really replicate a sleep test using a CPAP machine. The main reason is that even very low pressures may be preventing some of the obstructive events that you would have without CPAP. (For example, I need an exhale pressure of only 5 to treat moderate and mostly obstructive apnea.)

* You need to deal with the large leaks. During these leaks your machine can't treat whatever events you are having, or identify what type they are. You should not discount the unidentified events.

* If your mouth tape was intact at the end of the night, then your leaks are probably mask leaks. Any thoughts about how that might be happening? You might want to watch a mask-fitting video for your mask to see whether there are any little tricks you could try. You should do at least part of the fitting while lying down in bed in your usual sleep position(s).

* If your mouth tape failed, then you might try Somnifix or Fixomull Stretch.
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#6
RE: Can an APAP replicate a Home Sleep Test?
Thankyou so much for your responses.

My CPAP Rx was based exclusively on a home test preceded by a cursory video session with the sleep physician. 
The results were reported, following my request, as "48 events/h and SpO2 as low as 84%." I will request the formal record of the test itself
from either the clinic or the vendor of the home test. 

I have in addition the usual constellation of presenting symptoms: past reports from my wife (recently deceased) of interrupted breathing during sleep, frequent awakening during the night, and daytime drowsiness (I dismissed as "reveries") preceding and following her passing last June. Moreover, even after the first brief APAP session in late October and continuing until now, daytime drowsiness is much alleviated. I hope these benefits are sustained, and not just a psychological boost under the gun of achieving Medicare compliance!

Regarding mouth leaks, I have already used Somnifix but have invariably found the tape blown off at session's end.

I will experiment with a constant low pressure, acknowledging the limitations you describe.

Again, many thanks!
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#7
RE: Can an APAP replicate a Home Sleep Test?
Have you tried a chin strap (chin restraint) available wherever CPAP supplies are sold. A soft cervical collar is another option. But the best option is a full face mask.

You cannot succeed unless you get your leaks under control.
Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Can an APAP replicate a Home Sleep Test? .. attached Home Sleep Test
In response to the request by commenters to this thread I attach stated findings from the Home Sleep Test that resulted in prescribing of APAP:

https://www.dropbox.com/s/o4t81y5wckscp1...y.jpg?dl=0
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#9
RE: Can an APAP replicate a Home Sleep Test?
That is a summary only.  The full study would include sharts and tables.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#10
RE: Can an APAP replicate a Home Sleep Test?
Thankyou. I will pursue the original data; I suspect it is with the sleep study vendor and not with my physician.
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