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Newbie with questions
#1
I got my sleep study results back today and am having trouble understanding the results. The Dr was very rushed with me and did not explain pretty much anything even though I had questions and am hoping some of you might help me to understand better?

I was recommended a CPAP and go for titration later this month.

Sleep time: 330 min
AHI @ 20.18 per hour.
23 total apneas, 88 partial apneas.

111 respiratory events. 110 obstructive. 1 mixed.

The average baseline for oxygen desaturations was 100% and the minimum SaO2 during a desaturation event was 93%. Average event duration was 16 seconds and maximum duration was 42 seconds.

Snore: Mild

Notes: I have generalized anxiety disorder so I wasn't expected to sleep well during the text in an unfamiliar place with someone watching me etc.

Questions: How are my oxygen levels so high? How can I have 20.18 per hour AHI when there were only 23 apneas total?

Any help would be amazing. I am coming to terms with my diagnosis and am having bariatric surgery so hopefully this won't be a problem forever but I really don't understand some of these results.
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#2
Hi -- Those "partial apneas" are likely hypopneas and they do factor into the AHI. I've never seen them referred to as "partial apneas" on a sleep study report though.

As for your O2 levels, I don't have an explanation to offer, just that some people with apnea don't have a lot of 02 drops during apnea/hypopnea events.
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#3
What was the recommendation contained in the report? It sounds like you had a sleep study that diagnosed moderate obstructive sleep apnea, and there "might" be indications of upper airway resistance (UARS) syndrome. The study did not include a titration to determine therapeutic pressure. So the next step may be a recommendation for titration study, or simply prescription for an auto titrating CPAP. If you are cost-sensitive, you should strongly advocate for the latter option. If cost or insurance isn't a problem, the study to evaluate your response to CPAP may be of value.
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#4
(12-01-2015, 01:54 PM)Sleeprider Wrote: What was the recommendation contained in the report? It sounds like you had a sleep study that diagnosed moderate obstructive sleep apnea, and there "might" be indications of upper airway resistance (UARS) syndrome. The study did not include a titration to determine therapeutic pressure. So the next step may be a recommendation for titration study, or simply prescription for an auto titrating CPAP. If you are cost-sensitive, you should strongly advocate for the latter option. If cost or insurance isn't a problem, the study to evaluate your response to CPAP may be of value.

Yes, you are correct but no mention of UARS. I have no daytime sleepiness at all and this was just a clearance for surgery. I have a titration study later this month but I guess that was my question too, why can't I just get the auto titrating one?

See I asked about an auto titrating CPAP and he in a hurry said it wasn't possible and would only be done if I didn't tolerate the CPAP. I can't imagine why?
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#5
(12-01-2015, 01:09 PM)NotSoSure Wrote: Questions: How are my oxygen levels so high? How can I have 20.18 per hour AHI when there were only 23 apneas total?
Hi NotSoSure and welcome aboard
Sleep time 330 minutes (5.5 hours) is pretty good, considering sleeping in a strange place with all the wires
AHI = 23 (total apnea events) + 88 (hypopnea or partial events) ÷ 5.5 (sleep time) = 20.18 events per hour
AHI = 20.18

Sometimes, RDI http://www.apneaboard.com/wiki/index.php...ndex_(RDI) is used instead of AHI which also include arousal events, arousals can affect sleep quality and how you feel during the day

Apnea or hypopnea events need to last at least 10 seconds or more to be scored, shorter events may result in no significant oxygen level drop
All apnea and hypopnea events are obstructive type which is a good news which are easily treated with CPAP machine (golden standard treatment) http://www.apneaboard.com/wiki/index.php...ne_Choices

While waiting for the titration study, read about mask choices, mask choice is the most essential for effective treatment http://www.resmed.com/int/clinicians/com...nc=dealers

Best of luck with the sleep study and the surgery
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#6
Having just been through this I don't understand while especially for someone who has never used a CPAP machine they would suggest a titration study rather than initially using an APAP for a month or two. After that if it is believed the addition data generated in a titration study is important, it could be done at that time with a much greater chance of success.

In my case the titration study was a disaster. I slept very little and when they increased the pressure I woke up so little useful data was generated. They suggested a second titration study with some additional accommodations that they thought would help me sleep. Fortunately the PA that is a sleep specialist with the clinic recommended canceling the scheduled titration study and prescribed an APAP.
It took me a week before I could fall asleep with the mask on. It's been a little over a month now and I'm sleeping very well the APAP with AHI's consistently under 5.
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#7
(12-01-2015, 02:47 PM)Jimsp1 Wrote: Having just been through this I don't understand while especially for someone who has never used a CPAP machine they would suggest a titration study rather than initially using an APAP for a month or two. After that if it is believed the addition data generated in a titration study is important, it could be done at that time with a much greater chance of success.

In my case the titration study was a disaster. I slept very little and when they increased the pressure I woke up so little useful data was generated. They suggested a second titration study with some additional accommodations that they thought would help me sleep. Fortunately the PA that is a sleep specialist with the clinic recommended canceling the scheduled titration study and prescribed an APAP.
It took me a week before I could fall asleep with the mask on. It's been a little over a month now and I'm sleeping very well the APAP with AHI's consistently under 5.

I totally agree. Especially with bariatric patients who will be experiencing weight loss after surgery, I can't imagine why he WOULDN'T want me on an APAP? It just seemed so confusing to me.
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#8
NotSoSure, you are entitled to respect from your doctor, no matter what his rush. Basic patient respect matters, and not listening or responding completely to your reasonable questions is not respectful. You have copy of the report, and therefore a diagnosis. You could use that disrespect as motivation to take that diagnosis to ANY doctor for an appropriate prescription. I noticed yesterday that a new supplier was brought to our attention by a forum member, and the advisory members are currently voting whether to include that vendor on the supplier list linked at the top of this page.

The vendor has some interesting attributes such as providing prescriptions on the basis of a survey, and direct billing of insurance. While this is not an endorsement, I wouldn't blame you either. Just imagine the time and money savings that could result along with satisfaction of properly telling your current sleep doctor where to go.



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#9
NotSoSure,
You haven't said (unless I missed it) whether you have insurance coverage or not, but if you do, then know that insurance pays the same whether your doctor prescribes a Cpap or APAP.

Call your insurance and make sure what coverage you have, then ask your doctor to explain his comment about why it isn't possible and why it isn't done as far as prescribing an APAP. It sounds like he/she doesn't know what they are talking about.

A lot of docs don't like to perscribe an APAP, but it's to your benefit, not his. It can be set in Cpap mode if need be, but a Cpap cant be set to APAP mode.

You have a right to get the machine you want, and you need to consider that your needs may change in a year or so, and you will be glad you have that APAP.

OpalRose
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#10
(12-01-2015, 03:11 PM)Sleeprider Wrote: NotSoSure, you are entitled to respect from your doctor, no matter what his rush. Basic patient respect matters, and not listening or responding completely to your reasonable questions is not respectful. You have copy of the report, and therefore a diagnosis. You could use that disrespect as motivation to take that diagnosis to ANY doctor for an appropriate prescription. I noticed yesterday that a new supplier was brought to our attention by a forum member, and the advisory members are currently voting whether to include that vendor on the supplier list linked at the top of this page.

The vendor has some interesting attributes such as providing prescriptions on the basis of a survey, and direct billing of insurance. While this is not an endorsement, I wouldn't blame you either. Just imagine the time and money savings that could result along with satisfaction of properly telling your current sleep doctor where to go.

Thank you so much for the link. I will look into it for sure as well as contact my surgeon to see if I could be compliant by going this route.

I really appreciate the time you all have put in answering my questions. I am super grateful for the help and support, especially after my dr this morning had me so upset about his rudeness. I would LOVE to be able to go around him a bit and you're right, tell him exactly where to go!

(12-01-2015, 03:13 PM)OpalRose Wrote: NotSoSure,
You haven't said (unless I missed it) whether you have insurance coverage or not, but if you do, then know that insurance pays the same whether your doctor prescribes a Cpap or APAP.

Call your insurance and make sure what coverage you have, then ask your doctor to explain his comment about why it isn't possible and why it isn't done as far as prescribing an APAP. It sounds like he/she doesn't know what they are talking about.

A lot of docs don't like to perscribe an APAP, but it's to your benefit, not his. It can be set in Cpap mode if need be, but a Cpap cant be set to APAP mode.

You have a right to get the machine you want, and you need to consider that your needs may change in a year or so, and you will be glad you have that APAP.

I do have insurance coverage and I'm going to give them a call after work to find out for sure.

I try not to be an annoying "special snowflake" kind of patient but I really felt like he didn't know what he was talking about and barely spent enough time with me to make much more of an impression outside his rude attitude.

Thank you so much for your kind reply, much appreciated!
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