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[Treatment] Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
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Netskier Offline

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Post: #1
Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea rather than the AHI, which seems to be inflated with metrics of questionable clinical significance?

Obstructive Apnea is unquestionably life and life quality threatening, being able to precipitate heart attacks, strokes, and cause hypertension and atrial fibrillation.

But what about Hyponeas which only lower air flow? Do they lead to decreases in the partial pressure of O2?

What about Clear Airway Apneas where not even the airway is restricted? I stop breathing, momentarily while awake, frequently, often when just thinking. I don't stop for long, and don't even ordinarily think of it as stopping breathing, but rather as just holding my breath momentarily. Now long duration CAs might lead to hypoxia, but how long does this take? Does anyone here have oximetry experience that can answer this?

And the same questions apply to the so-called non-specific apneas that Sleepy Head reports.

Netskier

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03-21-2012 11:46 PM
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TheDreamer Offline

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Post: #2
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
Both Apneas and Hypopneas are defined events that lead to a desaturation of O2 in the blood (or causing arousal or sleep fragmentation). In a sleep lab they can record the other details and document them. But its harder to an xPAP to detect the effects of the Apnea/Hypopnea events it detects. Though some machines do have pulse oximeter options.

I've tried a regular pulse oximeter a couple of times....gets really annoying when the alarm goes off because I momentarily dropped below 80%.

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03-22-2012 08:23 AM
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zimlich Offline

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Post: #3
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
All I (think) I know is that AHI is not the best indicator of the success of 'PAP therapy, but for a long time that's the best thing we had. New machines and software are reporting different kinds of events and people are using oximeters as an adjunct to their software. I am lucky that in spite if a more than normal AHI I have never desaturated (in lab and two overnight tests at home).
03-22-2012 09:05 AM
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Netskier Offline

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Post: #4
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
(03-22-2012 08:23 AM)TheDreamer Wrote:  Both Apneas and Hypopneas are defined events that lead to a desaturation of O2 in the blood (or causing arousal or sleep fragmentation). In a sleep lab they can record the other details and document them. But its harder to an xPAP to detect the effects of the Apnea/Hypopnea events it detects. Though some machines do have pulse oximeter options.

I've tried a regular pulse oximeter a couple of times....gets really annoying when the alarm goes off because I momentarily dropped below 80%.

The Dreamer.

Did the alarm ever go off from either hypopneas or clear airway events, or just from Obstructive Events?

My age is none of my mind's business. --- Netskier
03-22-2012 02:44 PM
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greatunclebill Offline

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Post: #5
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
i guess i'll keep looking at the total ahi number that the professionals look at. with treatment my oa number is very low, but all the other numbers are high, so my ahi is high. i'm certainly not going to ignore the other numbers whether they have an o2 impact or not. i'm not going to ignore them because i don't know what impact they have. all of these events affect our body to some degree or we wouldn't even know about them. nobody here in the forum is going to convince me that i should not look at ahi because nobody here has identified themself as a medical doctor that i could verify. i can't wait to ask my doctor some of these questions that come up. this may make a good subject for a poll. should we ignore ahi and concentrate on oa.
03-22-2012 03:19 PM
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zonk Offline

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Post: #6
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
(03-22-2012 03:19 PM)greatunclebill Wrote:  nobody here in the forum is going to convince me that i should not look at ahi because nobody here has identified themself as a medical doctor that i could verify.
May be the inventor of CPAP Dr Colin Sullivan or Dr David Rapoport (Medical Director of the Sleep Disorders Center at New York University School of Medicine in New York City)

http://www.apneaboard.com/forums/Thread-...ht=useless
03-22-2012 03:31 PM
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Netskier Offline

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Post: #7
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
(03-22-2012 03:19 PM)greatunclebill Wrote:  i guess i'll keep looking at the total ahi number that the professionals look at. with treatment my oa number is very low, but all the other numbers are high, so my ahi is high. i'm certainly not going to ignore the other numbers whether they have an o2 impact or not. i'm not going to ignore them because i don't know what impact they have. all of these events affect our body to some degree or we wouldn't even know about them. nobody here in the forum is going to convince me that i should not look at ahi because nobody here has identified themself as a medical doctor that i could verify. i can't wait to ask my doctor some of these questions that come up. this may make a good subject for a poll. should we ignore ahi and concentrate on oa.

I did not mean to suggest to not look at AHI, but rather to ask what is the clinical significance of its various components. If they are clinically significant, then it makes sense to think about how to reduce them.

At this point, I think we should advise people to first reduce OSA asap because it is dangerous, and because PAP can reduce OSA, and then to examine the other components of the AHI.

Is there evidence that PAP can reduce Central Apneas? PAP should be able to reduce hypopneas.

My age is none of my mind's business. --- Netskier
03-22-2012 03:50 PM
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greatunclebill Offline

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Post: #8
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
(03-22-2012 03:50 PM)Netskier Wrote:  
(03-22-2012 03:19 PM)greatunclebill Wrote:  i guess i'll keep looking at the total ahi number that the professionals look at. with treatment my oa number is very low, but all the other numbers are high, so my ahi is high. i'm certainly not going to ignore the other numbers whether they have an o2 impact or not. i'm not going to ignore them because i don't know what impact they have. all of these events affect our body to some degree or we wouldn't even know about them. nobody here in the forum is going to convince me that i should not look at ahi because nobody here has identified themself as a medical doctor that i could verify. i can't wait to ask my doctor some of these questions that come up. this may make a good subject for a poll. should we ignore ahi and concentrate on oa.

I did not mean to suggest to not look at AHI, but rather to ask what is the clinical significance of its various components. If they are clinically significant, then it makes sense to think about how to reduce them.

At this point, I think we should advise people to first reduce OSA asap because it is dangerous, and because PAP can reduce OSA, and then to examine the other components of the AHI.

Is there evidence that PAP can reduce Central Apneas? PAP should be able to reduce hypopneas.

i think it's splitting hairs because oa is a component of ahi. everything you do to lower ahi, which is to lower leaks and get the pressure right will lower the oa. there is nothing you can do to affect one of the components independenly except maybe real centrals which may be treated seperately. i'm not sure clear airway apnea is a central apnea or if they are reported correctly by the software. i think there's some question there. this is one definite question for my doctor.

how would you "advise" someone to lower oa vs lower ahi. i think you would do the same thing. or to lower hypopnea?

does anyone have higher treated oa than clear airway apnea or hypopnea? i mean in high numbers, not 1.2 vs 1.5, etc.
03-22-2012 04:34 PM
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JumpStart Offline

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Post: #9
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
(03-22-2012 03:50 PM)Netskier Wrote:  At this point, I think we should advise people to first reduce OSA asap because it is dangerous, and because PAP can reduce OSA, and then to examine the other components of the AHI.

If there is no (or reduced) OSA, then, by definition, isn't there no (or reduced) AHI? I don't mean to belittle your point, I'm just not sure I understand it. Dont-know Regardless of whatever other events may occur, if you reduce OSA, you must reduce AHI. After all, OSA refers only to apneic events.

Breathing keeps you alive. And PAP helps keep you breathing!
03-22-2012 04:37 PM
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Netskier Offline

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Post: #10
RE: Shouldn't the goal of PAP treatment be to minimize Obstructive Apnea?
(03-22-2012 04:34 PM)greatunclebill Wrote:  
(03-22-2012 03:50 PM)Netskier Wrote:  
(03-22-2012 03:19 PM)greatunclebill Wrote:  i guess i'll keep looking at the total ahi number that the professionals look at. with treatment my oa number is very low, but all the other numbers are high, so my ahi is high. i'm certainly not going to ignore the other numbers whether they have an o2 impact or not. i'm not going to ignore them because i don't know what impact they have. all of these events affect our body to some degree or we wouldn't even know about them. nobody here in the forum is going to convince me that i should not look at ahi because nobody here has identified themself as a medical doctor that i could verify. i can't wait to ask my doctor some of these questions that come up. this may make a good subject for a poll. should we ignore ahi and concentrate on oa.

I did not mean to suggest to not look at AHI, but rather to ask what is the clinical significance of its various components. If they are clinically significant, then it makes sense to think about how to reduce them.

At this point, I think we should advise people to first reduce OSA asap because it is dangerous, and because PAP can reduce OSA, and then to examine the other components of the AHI.

Is there evidence that PAP can reduce Central Apneas? PAP should be able to reduce hypopneas.

i think it's splitting hairs because oa is a component of ahi. everything you do to lower ahi, which is to lower leaks and get the pressure right will lower the oa. there is nothing you can do to affect one of the components independenly except maybe real centrals which may be treated seperately. i'm not sure clear airway apnea is a central apnea or if they are reported correctly by the software. i think there's some question there. this is one definite question for my doctor.

how would you "advise" someone to lower oa vs lower ahi. i think you would do the same thing. or to lower hypopnea?

does anyone have higher treated oa than clear airway apnea or hypopnea? i mean in high numbers, not 1.2 vs 1.5, etc.

I don't think it is splitting hairs, but rather an attempt at clearer conceptualization.

Which would you prefer: OA = 0 and AHI = 5, or OA = 4.9 and AHI = 4.9? I would tremendously prefer having zero OA, and I submit that it is common sense to do so, and that focussing on AHI is a distraction from clinical significance.

My age is none of my mind's business. --- Netskier
03-22-2012 07:59 PM
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