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[Diagnosis] Do I have UARS? - Printable Version

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Do I have UARS? - weiss27md - 03-30-2020

35,M
I know I've had sleeping issues for at least 5 years.  I have a history of reflux, bruxism, TMD, anxiety, sinus infections, headaches and the past couple years fatigue and irritability.  Had an in lab sleep study 5 years ago and basically said no sleep apnea.  4 months a go I got an at home sleep study and it showed very mild apnea with an AHI 0f 5.5.  This same doctor found I had a sinus infection and antibiotics did not clear it up.  He's a sleep specialist and allergy doctor.  So I qualified for sinus surgery, I had chronic nasal swelling for years.  I got balloon sinuplasty, turbinate reduction and septoplasty.  This did clear my nose up but still waking up tired.  My final follow up with this doctor is in 2 weeks.  This same doctors office also said I had a large tongue.  They said they cant consider me for a CPAP until the final appt.  In the meantime I saw another sleep specialist and he gave me the runaround too about my AHI being so low that he probably couldn't do anything.  Supposed to have another sleep study by this doctor but no word yet.  Nothing is looking promising yet.  And if I do get a CPAP it might be a while and all my research says I probably need a BiPAP.  I've tried everything to sleep better with no luck: wedge mattress, weighted blanket, different pillow, night guard, taping mouth, nasal rinses, magnesium, melatonin, diet changes, exercise, etc.  I've done a lot of research and I think I need a ResMed AirCurve 10 VAuto.  My main issue is I'm always tired and it has slowly been betting worse over the past couple years.  Not sure how much longer I'll make it.  Should I just buy a used BiPAP or wait several months and maybe still no help from doctors?


RE: Do I have UARS? - DeepBreathing - 03-30-2020

G'day weiss27md. Welcome to Apnea Board.

Your AHI is very low, but it's also a very crude measure of sleep disordered breathing. Are you able to post up your sleep study reports, please? They may indicate something else that's going on apart from apnea and hypopnea. We need to see the full study with charts and tables, not just the summary. Make sure you delete any personal ID before posting.

As this is a long term problem, I suppose you've had tests for anaemia, thyroid function, vitamin deficiencies etc?

Why do you think you need a bilevel machine? Is there anything specific that leads you to this conclusion?

Hopefully something will show up in your sleep study to give us a more solid basis for advice.


RE: Do I have UARS? - weiss27md - 03-30-2020

Thanks for the response.  Here is the link to my sleep studies.

imgur.com/gallery/MQH3uIL


RE: Do I have UARS? - Gideon - 03-30-2020

Your centrals appear to be idiopathic. That is doc-speak for I don't know why.  The wave form in your detail does not hint at being altitude, treatment-emergent, or CO2 derived.  

Your Central apnea is not, at least in your example, over 5 CAI.  This means that you do not "qualify" for an ASV.  
1 qualification for qualification is to have a CAI of > 5 while your obstructive events are < 5.

IMHO you should be on ASV.  The first step is to make sure your obstructive events are under 5 and remain there.  We can do this by setting the EPR to the 'comfort' setting of 2, Full Time.  Note, this action will likely raise your CAI to > 5 (see the above comment)

And NO, I do not believe that you have UARS.


RE: Do I have UARS? - weiss27md - 03-31-2020

I seem to have almost all the symptoms of UARS.

huffpost.com/entry/upper-airway-resistance_b_6649766

I just ordered a used bipap. I can't wait several more months.


RE: Do I have UARS? - Gideon - 03-31-2020

No question about your symptoms, your sleep study does not indicate RERAs.
You have a low AHI on 5.5 with half (2.2) being obstructive.  Low Obstructive events are typical of UARS.  What you are lacking is Flow Limitations, these would show up as RERAs, you have none.  RERAs are a series of Flow Limits ending in arousal.

A lab sleep study may show otherwise, I doubt it, the other possibility would be to see a nightly OSCAR chart in detail.  By that, I mean a detailed study of 2-3 minute views of the Flow Rate to check for Flow Limits that didn't get flagged.

Again I'd be extremely surprised to see that you have UARS (which many doctors call Flow Limitation).

Look into your sleep hygiene and other causes of your symptoms.


RE: Do I have UARS? - weiss27md - 03-31-2020

The at home sleep study didn't measure RERAs.  I'm trying to get an in lab sleep study done but no luck yet.  With everything going on it's more difficult than normal.  I just can't wait any longer.  Feeling more crappy every day.  Headaches are becoming more frequent and I'm so tired.


RE: Do I have UARS? - Gideon - 03-31-2020

The study specifically reported in RDI terms and specifically with 0 RERA events. You didn't have any per that test. See Item C in the PSG Findings.


RE: Do I have UARS? - weiss27md - 03-31-2020

Oh, yes, that test.  That in lab study was done 4 years ago.  I know I've been getting much worse since then.  Can't get an in lab study till May, maybe later.  I use a Garmin Vivosmart 4 right now to track my sleep.  Sometimes it's not bad, sometimes it is.  It all depends on the night.


RE: Do I have UARS? - Gideon - 03-31-2020

Which BiLevel are you getting? That, with OSCAR, should provide up to date info. I assumed the study was somewhat current.