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[Diagnosis] NOX T3 sleep study interpretation
#1
NOX T3 sleep study interpretation
Hey guys!

First post here. Just had my sleep study done, was finally hoping to get some answers for my terrible daytime tiredness and fatigue.

The doctor told me no treatment was needed and I should loose 20lbs instead. I’m around 21% bf, calculated with the u.s navy method. Have been doing strength training for 15+ years. He only looked at my BMI.

Things I noted:

- Lots of hr spikes to 110bpm from low 50s with RIP phase activation and a increase in Db at the same time.

- 31.8% flow limitation non-supine

- RIP phase activation during REM

- 73% snoring, peaking at 90Db+.

If you could look at my data and share some insights it would be greatly appreciated. I was wondering if it’s worth getting a second opinion from another doctor.


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#2
RE: NOX T3 sleep study interpretation
Not sure what you would gain by getting a second opinion or test. Does not hurt to try, but the results here are clear to me you need CPAP or other intervention.

Your numbers are marginal, no disagreement with the doc there. Losing weight is a good idea for all of us, but it will not stop the snoring nor improve flow limitations. You are likely waking yourself up with the snoring.

90 dB snoring is akin to having a lawnmower next to you. Having your airway ~32% should be dealt with as well. 

Not sure how insurance works in the land of midnight, but if you can do so get a doc to prescribe a CPAP so insurance covers it, or try to find a gently used machine locally. I would specifically request a ResMed AirCurve 10 Vauto or similar Löwenstein bilevel like the 25S. You could likely use a standard APAP like the ResMed Airsense 10 Autoset or 20A, but if you can get a bilevel go for it.
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#3
RE: NOX T3 sleep study interpretation
Thank you for the quick answer.

I was thinking about a second opinion for the “treatment”, (losing weight).

I also heard that home sleep tests sometimes underscore the severity due to the inability to score EEG and inaccurately tracking sleep time.

The daytime fatigue is far from mild, I’m never rested after 8-9 hours of sleep and require daily naps to barely function.

The snoring is pretty bad yes, could be heard in the next room.

Thanks for the recommendations, I will try to get another appointment.
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#4
RE: NOX T3 sleep study interpretation
Hi, 

My sleep test was also on the Nox T3.

You are classified as having mild sleep apnea.

Generally your results are not too bad, with an AHI at 6, oxygen desaturation at 5.9/h and SpO2 average at 93.4%.

Whilst your average pulse of 66.3 seems about right, what did catch my eye were your upper pulse rates at 113-123, which, on the face of it, seem rather high during night-time.

If they were just momentary peaks during REM sleep, OK I would understand. 

But if they were for longish periods, that would certainly cause poor quality of sleep, and the obvious question would be why a seemingly increased coronary workload is needed?

If you are having resistance from your doctor in paying attention to your symptoms, it may be helpful to start asking probing questions to justify his "opinion" and to give a logical answers.

Good luck for your next appointment. 

Go well prepared!
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#5
RE: NOX T3 sleep study interpretation
Without OSCAR data to review, we can only guess. Your daytime fatigue is most likely due to your SDB (sleep-disordered breathing) aka sleep apnoea. Your snoring is both a cause and effect of your SDB. 

Quite possibly it is UARS, but without seeing any charts I am assuming that based on your description. 

Home sleep tests are not as accurate as a lab test, but they are fine for directional guidance. 

You can get any doctor, dentist, or PA, pretty much anyone who can write a prescription, to give you a script for a CPAP. At least this side of the pond that is the case. Hopefully works the same way for you.

CPAP will most likely stop your snoring. You will sleep better, your partners will sleep better, your neighbors will sleep better, your pets will sleep better.
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#6
RE: NOX T3 sleep study interpretation
As regards getting a second opinion on your doctor’s suggested treatment - losing weight, I’ve attached a couple of links from Viv Veer, a UK ENT Surgeon who specialises in treating SDB. These cover this very subject and look at the misconceptions about the relationship between being overweight and SDB …and seeming prevalent in the medical profession too. It might be useful to share these with your doctor…

https://www.youtube.com/watch?v=mmgRPFrySFM

https://www.youtube.com/watch?v=rdR8SVCeSJg

https://www.youtube.com/watch?v=4xXm3P1CKHg

Also one of reading a NOX T3 sleep study…

https://www.youtube.com/watch?v=WkPjOmgh40A

The daytime fatigue you are experiencing (in the absence of high numbers (AHA / ODI, etc.), maybe points more towards UARS territory - and the (low) numbers that you do have, seem more driven by hypopneas. So I would be inclined to look at what’s going on with the lesser obstructions such as Flow Limitations and RERAs too, as that may be the root of your fatigue.

If you had a PAP machine (and in conjunction with using OSCAR), you would then see data that would give you a better idea of what was actually going on for you and you could probably draw some inferences about whether UARS was the issue. Given your doctor’s seeming reticence to entertain treatment, then you could always import one from the US - bizarrely, no prescription is required from a number of US suppliers on overseas sales.

From what I understand, UARS can really only be diagnosed by full PSG (i.e with an EEG component) - and even then, it doesn’t always get reported on. So you would probably need to specify that it was UARS that you were on the lookout for.

Again, with all these things, it could be that you have some other (as yet undiagnosed) ailment, that is causing your fatigue - so stay open to that possibility too.
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#7
RE: NOX T3 sleep study interpretation
AHI and RDI was also the same for the sleep study.

Could this suggest that RERAs wasn’t scored correctly? 

I posted the settings used in the study.


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#8
RE: NOX T3 sleep study interpretation
Possibly, but equally likely that there were minimal or no arousals. Without seeing OSCAR data or further sleep studies it is difficult to be certain.
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#9
RE: NOX T3 sleep study interpretation
I’m assuming that your NOX T3 scoring was done automatically by Noxturnal’s diagnostic software and so are based on the criteria they set out in your post - These will just be their standard clinical definitions and thresholds.

While a further lab based Type 2 (or 1) study that is manually scored by a sleep polysomnographic technologist might give you more insight into what was going on, I doubt that it would significantly change your ‘numbers’.

It might be worth self-administering both an Epworth and STOP-BANG questionnaire. These are usually the first tools used by doctors to screen for SDB and attempt to measure the impact of your fatigue and sleepiness as well as your susceptibility / likeliness of having SDB. They each have their limitations though, but they are easy to self-administer, are free and can be found online (see below). It’s always additional ammunition when speaking to your doctor and might help build your ‘case’ - maybe making your case based on the impact it is having on your day-to-day wellbeing, rather than pure ‘numbers’.

https://epworthsleepinessscale.com
http://stopbang.ca/osa/screening.php

I don’t really have any real experience of where snoring appears to be such a prominent element of a sleep test, but you’re snoring (at 73% of the night?) seems to dominate, followed closely by flow limitations (at 28% of night) and can only be adding to your arousals and so day-time fatigue. These are after all, just varying degrees of strangulation!

It might be worth getting a referral to ENT specialist to try and pinpoint where your snoring is coming from anatomically and if there are any remedies (surgical or otherwise). An ENT sleep specialist might be better placed to say what part your weight plays in your snoring, rather than simply your GPs supposition.

In sleep apnea, the more switched on sleep specialists would probably advise that the apnea was treated first, in order to assist the patient with their weight loss. Having SDB can generally make it very difficult to loose weight. I’m not sure if the same rational applies to snoring, but I would suspect that it does. But to loose 20 lbs safely would take a fair bit of time and meanwhile you would continue to suffer fatigue, with the possibility that the weight-loss might not actually address your snoring or so your daytime fatigue and tiredness.

Just putting this out there, its not intended as diagnosis or even analysis, but more to suggest that, rather than make the case with the numbers or scores, more importantly, is how this is impacting on your day-to-day wellbeing and quality of life. It’s so easy for a doctor to argue the numbers but more difficult to argue your lived experience.

Your lived experience, 'supported' by numbers, is difficult to argue against.
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