Finished HST, possibly negative?

[Mogy]

I have had a few of the home studies done with the Resmed Apnea Link. It does report a CA Index.
On my first test I had low oxygen as well. I spent almost the full 4 hours that I was asleep below 90%. My AHI was 20 and my diagnosis was moderate OSA with something else that couldn't be determined by the HST.
I got my APAP right away and an oximeter 2 weeks later. I compared my oxygen levels while using the APAP and while not using the APAP. It made approximately a 1% increase in my steady oxygen level, and levelled out many of the dips.
I have GERD, and I feel that the acid was damaging my lungs. Once I started treating the GERD my oxygen level increased significantly. Now, my oxygen level stays around 95%. The APAP is also supposed to reduce GERD.

[deathscreton]

I have had a few of the home studies done with the Resmed Apnea Link. It does report a CA Index.
On my first test I had low oxygen as well. I spent almost the full 4 hours that I was asleep below 90%. My AHI was 20 and my diagnosis was moderate OSA with something else that couldn't be determined by the HST.
I got my APAP right away and an oximeter 2 weeks later. I compared my oxygen levels while using the APAP and while not using the APAP. It made approximately a 1% increase in my steady oxygen level, and levelled out many of the dips.
I have GERD, and I feel that the acid was damaging my lungs. Once I started treating the GERD my oxygen level increased significantly. Now, my oxygen level stays around 95%. The APAP is also supposed to reduce GERD.

Indeed, it does report effort values, but only with the raw data. The report they present you is a broken up version that cuts a lot of the information from it to help present it in a consumable way. What we're missing here is both the flow waveform(breathing) and the effort waveform, both of which would help further my guess as to what might be causing my oxygen saturation values on the last page.

And thankfully you've found what was causing your problems! It's fortunate you found it so soon. Was there any other indicators pointing to GERD? How did you figure?

[Sleeprider]

I think your analysis of your HST results shows a lot of awareness of the scope and diversity of potential sleep disordered breathing. I completely agree with your conclusions. One thing to keep in mind with chronic flow limitation is that it hides hypopnea by reducing baseline respiratory flow and volume. As a result the 50% flow reduction generally required to score hypopnea is actually much closer to an apnea. In other words, flow is already impaired to hypopnea levels all the time. We can usually see this in reading a flow rate chart. A better definition of hypopnea is:

"Hypopnea is defined as reduction in ventilation of at least 50% and/or a decrease in arterial saturation of 4% or more due to partial airway obstruction"

Under this definition you score nearly continuous hypopnea through the night. The person reading the results has to do some interpretation to gauge the severity of the flow limit is actually continuous obstructive hypopnea. If you have the results of your study, you can look at your tidal volume, and you may find it is actually under 400-500. Your normal tidal volume is probably above 500 mL. Similar reductions would be visible on minute vent, and of course the shape of the respiratory flow rate would be a dead give-away.

I actually think the details of the HST would be sufficient to recommend CPAP if interpreted by a more competent physician that takes into consideration the other components of your anecdotal history as you have related it in this thread, with snoring, breathing cessations, fatigue, weight, etc. I have no doubt that you would notice an immediate benefit, and that a data-capable machine would give you feedback to enable a good self-titration. My recommendation is to take your HST, preferably with full details, to your primary care physician and discuss it. I think you could walk out of the appointment with an Auto CPAP script in hand. Alternatively request a second opinion of the HST results. If you see a sleep specialist, they will inevitable want more studies and a clinical titration. For many reasons, I question the value of that, however you say you have good insurance, so costs would be covered. Such studies would of course take about 2-3 months to complete before you get the treatment you apparently need.

Simplest solution? Just buy the Resmed Airsense 10 Autoset on Amazon for $459, add an Airfit P10 mask for about $80 and start using it. Talking to your doctor with the detailed HST in hand may be your best legitimate shortcut to insured coverage for a machine.

[richb]

Hi deathscreton. I just read through this thread and found your case to be very interesting. You do have a significant desaturation problem. It had been suggested that you find out your daytime O2 saturation levels for a comparison. Buy a pulse oximeter (goes on the end of your finger) and write down your readings over time or get one that records the data for you. You need to know if there are significant differences between daytime and nighttime readings. You should be checked for possible COPD and cardiac issues which could involve O2 desaturations. Some pain medications (opioids in particular) can depress overall respiration. SR has pointed out your overall depressed respiration which makes it difficult to identify apneas. I would hope that you can get a proper sleep study with brain wave measurement etc. You can of course buy a ResMed machine and try it but it wont tell you much about pulmonary or cardiac conditions that might need treatment as well.

Rich

[deathscreton]

I think your analysis of  your HST results shows a lot of awareness of the scope and diversity of potential sleep disordered breathing. I completely agree with your conclusions.  One thing to keep in mind with chronic flow limitation is that it hides hypopnea by reducing baseline respiratory flow and volume.  As a result the 50% flow reduction generally required to score hypopnea is actually much closer to an apnea. In other words, flow is already impaired to hypopnea levels all the time.  We can usually see this in reading a flow rate chart.  A better definition of hypopnea is:

"Hypopnea is defined as reduction in ventilation of at least 50% and/or a decrease in arterial saturation of 4% or more due to partial airway obstruction"

Under this definition you score nearly continuous hypopnea through the night.  The person reading the results has to do some interpretation to gauge the severity of the flow limit is actually continuous obstructive hypopnea.  If you have the results of your study, you can look at your tidal volume, and you may find it is actually under 400-500.  Your normal tidal volume is probably above 500 mL.  Similar reductions would be visible on minute vent, and of course the shape of the respiratory flow rate would be a dead give-away.

I actually think the details of the HST would be sufficient to recommend CPAP if interpreted by a more competent physician that takes into consideration the other components of your anecdotal history as you have related it in this thread, with snoring, breathing cessations, fatigue, weight, etc.  I have no doubt that you would notice an immediate benefit, and that a data-capable machine would give you feedback to enable a good self-titration.  My recommendation is to take your HST, preferably with full details, to your primary care physician and discuss it.  I think you could walk out of the appointment with an Auto CPAP script in hand. Alternatively request a second opinion of the HST results.  If you see a sleep specialist, they will inevitable want more studies and a clinical titration.  For many reasons, I question the value of that, however you say you have good insurance, so costs would be covered.  Such studies would of course take about 2-3 months to complete before you get the treatment you apparently need.

Simplest solution?  Just buy the Resmed Airsense 10 Autoset on Amazon for $459, add an Airfit P10 mask for about $80 and start using it.  Talking to your doctor with the detailed HST in hand may be your best legitimate shortcut to insured coverage for a machine.

I would love to dish out 500 dollars for a xPAP machine, but I don't have that kinda cash on hand unfortunately. What I'll end up having to do is probably going through my Primary doctor. That being said, it's good to know that this test, however limited in it's results, have shown promise in clarifying my issue. 

PS: Sleep Group said that they can't give me my raw data. They didn't even specify a reason for it. I'm sending them an email hopefully to clarify their reasoning for this. I really don't want this to get more difficult than it has to be. (Has anyone else had issues similar to this?)

Hi deathscreton.  I just read through this thread and found your case to be very interesting.  You do have a significant desaturation problem.  It had been suggested that you find out your daytime O2 saturation levels for a comparison.  Buy a pulse oximeter  (goes on the end of your finger) and write down your readings over time or get one that records the data for you.  You need to know if there are significant differences between daytime and nighttime readings.  You should be checked for possible COPD and cardiac issues which could involve O2 desaturations. Some pain medications (opioids in particular) can depress overall respiration.  SR has pointed out your overall depressed respiration which makes it difficult to  identify apneas.  I would hope that you can get a proper sleep study with brain wave measurement etc.  You can of course buy a ResMed machine and try it but it wont tell you much about pulmonary or cardiac conditions that might need treatment as well.  

Rich

Hello Rich! 

I actually planned on purchasing a CMS 50D+ for overnight recording for when I get a xPAP, should the need arise. I also wanted to use it to, as you said, record my daily oxygen levels. I think this would help me with my overall case regarding UARS. I do appreciate your input!

[chill]

I was going to suggest UARS as a possibility.  It fits with the test results and your symptoms.

[deathscreton]

I was going to suggest UARS as a possibility.  It fits with the test results and your symptoms.

Oddly enough, on other boards, I've been met with slight resistance as to that being a possibility. But besides sleep hygiene and other outside factors, they can't seem to give me any clues as to what else this data might point to. 

To be fair, we don't have all the data, and they don't have extensive access to my medical background, so it makes sense that they wouldn't be able to offer many other explanations. Still, I think this fits. I'll be happy to take other suggestions. Someone mentioned COPD. I might look into that as well.

[richb]

Looks like you should be setting up that full polysomnogram. You mentioned "my medical background". Have you had a cardiac work up including an echo-cardiogram? You probably also need to be seen by a pulmonologist (UARS COPD). Your medical condition needs to be taken seriously so that you can get the best course of treatment. You may have a lot more going on than just some "borderline sleep apnea".

Rich

[deathscreton]

I think your analysis of your HST results shows a lot of awareness of the scope and diversity of potential sleep disordered breathing. I completely agree with your conclusions. One thing to keep in mind with chronic flow limitation is that it hides hypopnea by reducing baseline respiratory flow and volume. As a result the 50% flow reduction generally required to score hypopnea is actually much closer to an apnea. In other words, flow is already impaired to hypopnea levels all the time. We can usually see this in reading a flow rate chart. A better definition of hypopnea is:

"Hypopnea is defined as reduction in ventilation of at least 50% and/or a decrease in arterial saturation of 4% or more due to partial airway obstruction"

Under this definition you score nearly continuous hypopnea through the night. The person reading the results has to do some interpretation to gauge the severity of the flow limit is actually continuous obstructive hypopnea. If you have the results of your study, you can look at your tidal volume, and you may find it is actually under 400-500. Your normal tidal volume is probably above 500 mL. Similar reductions would be visible on minute vent, and of course the shape of the respiratory flow rate would be a dead give-away.

I actually think the details of the HST would be sufficient to recommend CPAP if interpreted by a more competent physician that takes into consideration the other components of your anecdotal history as you have related it in this thread, with snoring, breathing cessations, fatigue, weight, etc. I have no doubt that you would notice an immediate benefit, and that a data-capable machine would give you feedback to enable a good self-titration. My recommendation is to take your HST, preferably with full details, to your primary care physician and discuss it. I think you could walk out of the appointment with an Auto CPAP script in hand. Alternatively request a second opinion of the HST results. If you see a sleep specialist, they will inevitable want more studies and a clinical titration. For many reasons, I question the value of that, however you say you have good insurance, so costs would be covered. Such studies would of course take about 2-3 months to complete before you get the treatment you apparently need.

Simplest solution? Just buy the Resmed Airsense 10 Autoset on Amazon for $459, add an Airfit P10 mask for about $80 and start using it. Talking to your doctor with the detailed HST in hand may be your best legitimate shortcut to insured coverage for a machine.

I was going to suggest UARS as a possibility.  It fits with the test results and your symptoms.

Looks like you should be setting up that full polysomnogram. You mentioned "my medical background". Have you had a cardiac work up including an echo-cardiogram? You probably also need to be seen by a pulmonologist (UARS COPD). Your medical condition needs to be taken seriously so that you can get the best course of treatment. You may have a lot more going on than just some "borderline sleep apnea".

Rich

Hey all, I wanted to let you know that I received both my OSA file (after speaking with the Sleep Study Director and teaching her that her program had features they weren't aware of ) and a proper way to view the files.

I'm gonna say these results look... Interesting. I'm still learning what I'm reading, but the file is available is anyone wants to view it. The program is quite indepth, but GOOD LORD does it contain information I want. I may end up spending all night looking at this instead of playing games like I originally planned.

[deathscreton]

Apologies for the double post, but I wanted to place this here:



Above is a picture of my record file straight from the sleep study with no edits. This is what the report on the first page is created from. I've also worked out how to remove personal information from the records so the OSA and EDF files are available to anyone whose interested. You can find the OSA here:

https://drive.google.com/open?id=0ByfEUm...mVDaWhZNVU

It should be noted that the above OSA file has two reports. The bottom report should show an AHI of 4. This report is similar to the created by the Sleep Study. I recreated this one to remove personal information. The top report will show a different story. I created this report with a single variable change, dropping the threshold for oxygen desat events from 4% to 3. The reason I did this is that when doing sleep tests, following AASM guidlines for clinical diagnostics, there are two definitions for oxy desats. The first is if the group is NOT accounting for cortical arousals, then the desat even is set a 4%. If they ARE accounting for arousals (via EEG), then desat events are set for 3% (https://drive.google.com/open?id=0ByfEUm...0xuUi1mbFU  See bottom of page 480 and continue to page 481).

This report shows a different story completely. I've attached a picture of the the accompanying record and report below as another link in PDF format:

https://drive.google.com/open?id=0ByfEUm...HEtVWstWEU

Let me know what you think. I'm still trying to understand waveform patterns and how to distinguish what they mean.