[Equipment] UARS diagnosis - Which machine should I get?

[OpalRose]

An ASV is recommended for those that have been diagnosed with Central Sleep Apnea. Unless this was reported on your sleep tests, there is no need for an ASV.

You could post your sleep studies here for more accurate advice.

[cinematic6436]

Here you go. This is my most recent sleep study. I only have a hard copy of the August study, and I'd rather not have to scan it (my printer is evil).

    Cleveland Clinic Sleep Disorders Center at Independence         
    5051 W Creek Rd, Independence, OH 44131         
    Tel: (216)444-2165; Fax: (216)445-6205         
            
    PSG Study Report         
            
    Name: Date of Study: 4/25/2021 CCF#: 87196941         
    Age: 39 (DOB: / / ) ESS: 7/24 Neck Circ. (cm): 37         
    Height (cm): 188.0 Weight (kg): 86.2 BMI: 24.4         
    Referring Provider: Mailcode: Max         
            
    Sleep history: The patient is a 39 year old male with a history of multiple         
    awakenings from sleep, fatigue, and nightmares. A polysomnogram performed on         
    8/30/2020 showed upper airway resistance syndrome. The overall apnea hypopnea         
    index (AHI) of 1, supine AHI of .8, REM AHI of 1.6, respiratory disturbance         
    index (RDI) of 9.7, and oxygen saturation (nadir of 91%). Due to persistent         
    symptoms the patient requested an additional sleep study to try and qualify         
    for CPAP therapy. The patient endorses being a habitual side sleeper.         
    Past medical history: Depression, Insomnia, Upper Airway Resistance Syndrome         
    Medications: Advil, Zanaflex, Unisom         
    Sleep procedure: PSG 4 or more addtl param PC (95810)         
            
    Procedure: The study was attended continuously by a sleep technologist. The         
    monitored parameters included: left (E1-M2) and right (E2-M1) EOG, frontal         
    (F3-M2 & F4-M1), central (C3-M2 & C4-M1) and occipital (O1-M2 & O2-M1) EEG,         
    mental and submental EMG, left and right anterior tibialis EMG, single ECG         
    waveform, snoring, continuous airflow with thermistor and nasal pressure         
    transducer, chest and abdominal effort, oxygen saturation, ETCO2, and body         
    position via video monitoring.         
            
    Hypopnea definition: The peak signal excursions drop by = 30% of pre-event         
    baseline using nasal pressure (diagnostic study), PAP device flow (titration         
    study) or an alternative hypopnea sensor (diagnostic study). The duration of         
    the = 30% drop in signal excursion is = 10 seconds. There is a greater than         
    or equal to 4% oxygen desaturation from pre-event baseline.         
    Respiratory Effort Related Arousal (RERA) definition: 10 seconds         
    characterized by increasing respiratory effort or by flattening of the nasal         
    pressure or PAP flow waveform leading to arousal from sleep when the sequence         
    of breaths does not meet criteria for an apnea or hypopnea.         
    Respiratory Disturbance Index (RDI) definition: RDI = (#apneas + #hypopneas +         
    #RERAs) x 60 / TST.         
            
    SLEEP ARCHITECTURE:         
    The study started at 22:34:29 and ended at 05:15:38. Total sleep time (TST)         
    was 282 minutes resulting in a sleep efficiency of 71.8% (total recording         
    time (TRT) = 393 m). There were 48 awakenings with a total time awake after         
    sleep onset of 102.0 minutes. The sleep latency was 8.5 minutes and the REM         
    latency was 160 minutes. The patient spent 46.6% of sleep time in the supine         
    position. The sleep stage percentages were 22.7% stage N1, 62.6% stage N2,         
    7.3% stage N3 and 7.4% REM sleep. There were 259 arousals, resulting in an         
    arousal index of 55.1. There were 238 stage shifts.         
            
    RESPIRATORY DATA:         
    Snoring was noted. There were 62 respiratory events consisting of 1         
    obstructive apnea, 7 hypopneas, and 54 RERAs. The apnea-hypopnea index (AHI)         
    was 1.7 and the central-apnea index (CAI) was 0. The respiratory effort         
    related arousal (RERA) index was 11.5. The respiratory disturbance index         
    (RDI) was 13.2. The mean oxygen saturation during the study was 95.0%, with a         
    minimum oxygen saturation of 92.0%. The wake supine end-tidal CO2 (ETCO2)         
    value was ~38 mmHg. The maximum ETCO2 was 43 mmHg. Cheyne-Stokes/Periodic         
    Breathing was not present. Supplemental oxygen was not administered.         
            
    REM-Time REM AHI NREM-Time NREM AHI Total-Time Total RDI Total AHI         
    Supine 16.5 m 0.0 115.0 m 2.1 131.5 m 16.9 1.8         
    Off-Supine 4.5 m 0.0 146.0 m 1.6 150.5 m 10.0 1.6         
    Total 21.0 m 0.0 261.0 m 1.8 282.0 m 13.2 1.7         
            
    MOVEMENT DATA:         
    No abnormal behavior or motor activities were noted. There were 31 periodic         
    limb movements during sleep, resulting in a PLM-index of 6.6. Of these, 4         
    movements were associated with arousals, resulting in a PLM-arousal index of         
    0.9.         
            
    ECG DATA:         
    The average heart rate during sleep was 43 beats per minute, with a range of         
    36 to 75. During wake, the heart rate ranged from 38 to 71 beats per minute.         
    The following arrhythmias were observed:, Premature ventricular contractions.         
            
    ICSD DIAGNOSIS:         
    Upper Airway Resistance Syndrome [G47.8]         
            
    IMPRESSION:         
    1. Upper airway resistance syndrome (UARS) is a subtype of obstructive sleep         
    apnea (OSA). UARS was also diagnosed on 9/30/2020. Although the overall         
    apnea-hypopnea index (AHI) was in the normal range, the respiratory         
    disturbance index (RDI) was in the mild range, indicating potential clinical         
    significance. Severity of the sleep-related breathing disorder may be         
    underestimated due to the presence of mild flow and effort decrements         
    associated with arousal and/or oxygen desaturation not meeting established         
    CMS respiratory event criteria.         
    2. Abnormal sleep architecture likely due to respiratory events and first         
    night effect.         
            
    RECOMMENDATIONS:         
    Treatment of upper airway resistance syndrome (UARS) can include exercise,         
    weight loss, treatment of allergies, positional therapy, dental appliance or         
    surgical correction of any airway abnormalities may also improve signs and         
    symptoms.         
            
    INTERPRETING PHD BOARD CERTIFIED SLEEP SPECIALIST:         
            
    I attest that I have performed epoch by epoch review of the entire raw data.         
            
    Ralph Downey III, PhD, FAASM         
            
    INTERPRETING PHYSICIAN:         
            
    I attest that I have performed epoch by epoch review of the entire raw data.         
            
    Reena Mehra MD, MS, FCCP, FAASM         
    Diplomate of the American Board of Sleep Medicine         
            
    ----------         
    Report Digitally Signed By:         
    REENA MEHRA M.D. (4/28/2021 8:18:55 AM)

[sheepless]

"There were 31 periodic limb movements during sleep, resulting in a PLM-index of 6.6. Of these, 4        movements were associated with arousals, resulting in a PLM-arousal index of  0.9."     

I'll just say that no matter what they tell you, my experience is that these can really mess with your sleep & your pap therapy.

[OpalRose]

I don't know anything about PLM, so will leave that to sheepless, who seems to be our expert with PLM.

But you have definitely been diagnosed with UARS. It may be hard to get insurance coverage for UARS, but doesn't hurt to try. There were no Clear Airway noted on your tests, so there is no need for an ASV.

The ResMed AirCurve 10 VAuto would be your best bet. If you have to buy out of pocket, check Supplier #2 as they sell low hour used machines and new open box. Many have purchased from them and they have a good reputation.

Good luck in whatever you decide to do.

[cinematic6436]

One last question -- judging from the results posted above, is it possible to tell if the odds are against me that the ENT I have an appointment with in the coming weeks will prescribe either the Airsense 10, the Aircurve 10 Vauto, or anything at all? I know only the doctor will be able to give me a definitive answer, but anything anyone could tell about about their dealings with UARS, doctors and insurance would be helpful.

[Gideon]

The odds are against a VAuto, being an ENT surgery is a possibility.
Of Machines, a CPAP is likely to be prescribed,  You would like him to specifically prescribe a ResMed AutoSet or AutoSet for Her.  You are good if he doesn't specify a brand because then you and insist on a ResMed AirSense 10 AutoSet from the DME, if they refuse you just need to go to another DME that caries ResMed products.

[cinematic6436]

Is the efficacy of the Aircurve Vauto over the Autoset worth it to go out of pocket on the Aircurve Vauto? I'll probably bite the bullet and wait until the end of the month for my appointment to see what the doctor says, I'm just fed up with being tired throughout the day...

When I do get either machine, I plan on using Oscar. Is there a number of days I should wait before posting data to evaluate how I'm sleeping? Would it be okay to post it here, or should I start a new thread?

[Gideon]

Wait one night, then post your charts.
This is YOUR thread so always post in this thread. If you want the title changed, just ask.

The ability to use more than 3 cmw for PS is a significant advantage.
To get it with insurance you will most likely need to fail at CPAP and since you most likely will have low AHI you will never 'fail' on a CPAP/APAP.

IMHO the VAuto is a better machine for everyone. It can match pretty much any CPAP/APAP setup and go well beyond if needed. IMHO for UARS, which is what it looks like you have it is the best machine.

Read this Wiki Article http://www.apneaboard.com/wiki/index.php..._and_BiPAP

[SarcasticDave94]

I too agree the AutoSet is possible to be scripted with your above test results. VAuto likely not. As is they'd rather do surgery, and if done, you'll still need PAP.

[slowriter]

Is the efficacy of the Aircurve Vauto over the Autoset worth it to go out of pocket on the Aircurve Vauto? 

I think it's impossible to answer that question in general, as whether you would be benefit from the greater flexibility is unknown, as is how you gauge whether it's "worth it" (e.g your financial situation, etc.).

I will tell you I went out of pocket for a few reasons:

1. I wanted to experiment with greater pressure support not available on the autoset.
   
2. I was tired of hassling with doctors and insurance companies.
   
3. I found a deal on a lightly used machine that was similar to cost if I went with the insurance option; before I ultimately did get insurance approval.