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[Treatment] AHI is widely variable...Why?
#1
AHI is widely variable...Why?
I started treatment for sleep apnea a short time ago with a total of 40 nights of treatment so far.  AHI is widely variable...Why?...with no apparent improvement since starting treatment.  Additionaly...How reliable is the AHI and the number of events reported by my Airsense 10 (APAP) equipment.

Below are three reports...My 2nd, 6th and 8th nights of treatment.  Over the last 40 nights...AHI can be very low one night...very high the next night or anything in between with the types of events being widely variable as well.  Is this normal?

I have found my health care provider to be reactive only...I know they get these reports...should I expect them to review the reports and be in touch with me or should I be more proactive and contact them?  They are the proffessionals...what shoud I expect? 

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#2
RE: AHI is widely variable...Why?
Hi and welcome to the board!

The images were incorrectly attached - Could you try attaching them again?

The machine you have is generally regarded as the best APAP/CPAP machine out there. No algorithm is perfect (and it's designed primarily with OSA in mind, so it doesn't differentiate between central and obstructive hypopneas, but it's going to spot significant events that meet the criteria. However, it is possible to have smaller "events" that are either too short or not quite restricted enough to meet the criteria for either an apnea or a hypopnea, and there are some settings in OSCAR to help spot some of those events.

Without seeing your images, I can't tell about the AHI. It depends how much the results vary by, the breakdown of events, and whether they're clustered in a way that suggests some positional apnea or not. Central Apnea especially is particularly variable - it's consistently inconsistent. And if you have the chin tucking of positional apnea, then the number of events is going to depend on how often you end up tucking your chin enough to "kink" your airway. And a small amount of variability isn't necessarily abnormal.

Hopefully, you can get those charts attached and we can take a look at the data.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#3
RE: AHI is widely variable...Why?
Use F12 button for the screenshot- it formats it correctly. Check my signature at the bottom of the post for arranging charts. 

Use the attach file at the bottom of the post
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: AHI is widely variable...Why?
This answer is without OSCAR data.

What to expect from the doctor? Question or 2 on how therapy is going. The face to face visit after you've been on therapy at least 1 month, insurance required this. The bills.

Seriously not much else. Y O U must self advocate! You need to call them, bug them often if you've any issue with the therapy. They are not going to proactively help you. You'll need to do all the work, they script it. I'm quite serious, they'll not be doing much for you.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#5
RE: AHI is widely variable...Why?
Thanks all for your replies...new to the forum...not sure how to post images and will learn as I go...thanks all for your patience.  Preview says I got it...

As in my first post...every night is different and ranges between below 5 AHI and near 50 AHI...Event type according to the report is widely variable...little change in 40 days.  Called my health care provider twice...got one call back, EPR turned off, breathing/exhalation effort became more comfortable.  No change in AHI, still widely variable after 40 days.


   

   

   

My equipment reports the bulk of my apneas are central so I don't expect much impovement...next step if any is what?

Hey, SarcasticDave94, thanks for your input...You ever feel like your job is doing everybody else's job?  

Bkind2all
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#6
RE: AHI is widely variable...Why?
I've been there before yes. Especially as a regional truck driver for 11 years. Dispatchers typically don't help but hinder. Stuff like that.

OK the mainly Central thing can be a real pain. And yes I do know from personal experience, having retired an ASV as not capable of my overly complex situ. And my '17 diagnosic posting 24 Obstructive Apnea, 124 Central with the longest CA being 90 seconds.

Action needed immediately, EPR and Ramp OFF! No weaning. We need your diagnosic report ASAP. Call the doc and request it very soon. You're in the US, so HIPAA law permits you to request and receive it. No isn't an acceptable answer from the doc. Directed action is not necessarily asking but demanding. Once you get the detailed version that you're demanding, you'll edit to redact personal info only. We need the full, multi-paged report. Those CA flags have used up the purple ink and caused a massive trainwreck. Ew.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#7
RE: AHI is widely variable...Why?
Thank you for your response...
 
I posted three reports in a response to SarcasticDave94...have a look?
 
Below are the results of a home sleep study done in Jan, 2021
 
Followed SarcasticDave94 advice to be persistent contacting my care provider/s... called each provider, left several messages... got some action and they agreed that my current treatment has had little affect...and scheduled an in-lab sleep study before moving on to the next device.


   

   
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#8
RE: AHI is widely variable...Why?
OK thanks, that study showed a few unclassified apnea but quite a lot of obstructive and hypopnea. It didn't mention use of an effort belt during that test, possibly wasn't.

I'm kinda thinking its headed towards idiopathic central apnea. A BPAP without backup rate will not be pretty, but I'm certain you will have to try and fail.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#9
RE: AHI is widely variable...Why?
Seconding what Dave said. Wow. I'd also suggest those obstructives may also be centrals too. The way that the machine works, it doesn't strictly find centrals. It looks for obstruction and if it finds less than a certain amount of obstruction, It labels it clear airway. But the thing is, you can have a central even with an obstructed airway - which is why you need a chest/belly respiratory effort monitor to accurately diagnose centrals. Considering how many centrals you're having, I wouldn't be at all surprised if those were mislabeled centrals - because it doesn't matter if your airway is completely blocked, if you aren't even attempting to breathe, it's a central event.

Your chart looks like mine right now only my minimum is around 10-12 CAI. The maximum on APAP is 58, during my sleep study it was 80+. The average is 30-40, mostly starting or worsening after the initial 30-90 minutes of sleep. My longest apnea was 90 seconds, though I did have two minute long ones with just a small huff between them that same night a few breaths before the 90-second one. And almost every night I have at least one apnea longer than 30 seconds.

Chase this up with your doctor ASAP.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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