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Why is AHI 5.0 OK?
#1
Why is AHI 5.0 OK?
Apologies if this has been discussed before but I couldn't find it if it has.

What was the reasoning behind the determination that an AHI of 5.0 or less is acceptable?

I have no problem with using this threshold, and for me it seems more or less OK in terms of how I feel in the morning and how disrupted my sleep was (though I never feel like I've had a great sleep, just some are less horrid than others).

I can see how getting to 5.0 or less would be wonderful after suffering 38 or more for years, like I and many others, so in any scenario 5.0 is a worthwhile achievement, but is there any robust science behind it?
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#2
RE: Why is AHI 5.0 OK?
I don't know if there's any real science there, or whether it's more a case of somebody needing to draw a line and saying "five will do".

Personally I need to get below two in order to feel good the next day, and I suspect a lot of people do as well. That's why you'll often see us say something along the lines of "The numbers say you're OK, but how do you actually feel?"
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#3
RE: Why is AHI 5.0 OK?
Absolutely. I think the "How do you feel" measure is important. I haven't figured out why yet, but my 'sweet spot' in terms of feeling well seems to be AHI 4 - 8. When I have a period of low AHI (say less than 2.0), I tend to feel lousy.
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#4
RE: Why is AHI 5.0 OK?
I didn’t know that 5 was OK. it’s not ok with me.
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#5
RE: Why is AHI 5.0 OK?
It is primarily an arbitrary threshold to qualify an individual for insurance reimbursement for CPAP equipment or oral devices. That threshold is the "tail wagging the dog" because it was a decision by an insurance committee that has been adopted by the entire sleep profession as something diagnostic and meaningful. AHI is one of many factors, including oxygen saturation, respiratory event related arousal, sleep quality etc. that are important in therapy and quantifiable. The reliance on a simple index is great for bean-counters, but not very meaningful for medicine.
Sleeprider
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#6
RE: Why is AHI 5.0 OK?
Not ok with me either!  Who wants to be strangled 5 times an hour?  I know it’s just an average, but still.....

I think all this is driven by insurance companies/Medicare.  They have to draw a line somewhere, and an AHI of 5 sounded good to somebody.  Rolleyes

I personally like to have an AHI under 2.  Most of the time, I can achieve an AHI of .5 to 1.5.

One thing I will stress though is....Don’t go chasing numbers.  An AHI reading can change night to night.  Some of the things that come into play are: stress, certain medicines, sickness, etc.

If you feel good with an AHI of 5.0, then all is well, but it doesn’t hurt to post your data here as we may see something that can help lower it a bit. Although, I’m not certain, but your machine may not be supported by SleepyHead.
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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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#7
RE: Why is AHI 5.0 OK?
(03-23-2019, 04:10 AM)StevesSp Wrote: Absolutely. I think the "How do you feel" measure is important. I haven't figured out why yet, but my 'sweet spot' in terms of feeling well seems to be AHI 4 - 8. When I have a period of low AHI (say less than 2.0), I tend to feel lousy.


4-8 would leave me feeling poorly but we're all a little different and more to the point I agree that our best nights aren't always the lowest ahi nights.   

I've finally been able to get my ahi's down under 1 most of the time but the lowest ahi nights aren't always the best in terms of how I feel the next day.  I think for me that's because 0.0's occur most often when my fragmented sleep sessions are short, my theory being that I don't reach deep enough sleep to trigger much apnea those nights.

how I feel isn't entirely a function of the effectiveness of pap either.  like many others I have problems affecting sleep besides apnea.  in my case periodic limb movements throughout the night cause many arousals I'm unaware of and eventually they wake me up.  I may be tired because of the plm even if I have a low ahi.

measures other than ahi can be considered.  for example, even if my ahi is low, my sleep efficiency may not be.  counting only full stop-the-machine awakenings (as opposed to frequent, usually shorter wake periods with mask left on), my time asleep vs time awake has often been below the 85% threshold I see in the context of sleep hygiene.
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#8
RE: Why is AHI 5.0 OK?
Hi there,

Maybe I can help here. I work in laboratory science so I know how these lines are drawn. With any medical test there are two ways that a "normal" is calculated. One, if you are looking at a total population for a norm is to test a large number of healthy subjects, measure, determine the average number then what the standard deviation range is. The other is a bit more complicated. First you measure a healthy population like above. Get a number. Then you measure the diseased population get a number. Then the diseased population also gets additional tests looking for other lab or health pathologies and a threshold for the "diseased" value is determined. The same then applies to the "healthy" population and the same tests are run. Then the value gets normalized within the original standard deviation.

The standard deviation accounted for why some of us feel good at 5, or 1 while others are ok at 8 or 10. For example my AHI has been at 0.3 this week and I just feel tired. Where as the last few weeks it has been at 1.3 and I felt better. Why? Who knows. It's just my physiology and chemistry.
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#9
RE: Why is AHI 5.0 OK?
My AHI number is is not well correlated with how well I feel after I get up. This is because my AHI is dominated by centrals that occur only early in the morning, during periods of sleep / wake junk during which i am drifting in and out of sleep. The best indicator of how I feel is with a low (<0.10) 95% flow limit. I feel best when I achieve this after sleeping for 8 or more hours. To achieve an 8-hour sleep I will usually see the central apnea number exceed 10/hr. I have even had feel-good nights when my AHI is greater than 10, all due to centrals. These are my 0,0 nights!
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