Finished HST, possibly negative?

[Rukel]

Hello all. If you frequent both this forum and Apneaboard, then you'll probably have seen this post already. If that's the case, I apologize, but I feel it's important that I reach out to all sources available to me regarding this so I can have the best grasp on what may end up being a life changing event.

To summarize, the subject line explains it all. I recently had an HST that came back negative, but had some worrying stats. The representative from the Sleep Study group said that she understood that most who take this test either are upset by it because it doesn't explain what they might be experiencing, or the individual is relived and happy to hear that OSA is not something else they have to contend with when trying to sort out their health. I'm the former. This is insanely devastating to me because I wanted this test to give me a reason as to what has been ravaging my sleep and sapping my daytime energy for years, not to mention the fact that my sleeping habits actually scares my significant other when she notices(she's actually woken me up a few times saying that I wasn't breathing and was wanting to make I was okay. Not a good night for either of us). In any case, the ST rep stated my case was unclear enough that a in-lab study may be necessary for multiple reasons. The one she outlined being the most outstanding was the fact that my Oxygen Saturation levels dipped to 81% at one point during the night. While asleep, I spent almost an hour at less than or equal to 89% saturation.

There are other worrying factors that I found disturbing, simply because they made no sense to me, like my max BPM being around 140. I feel this may have been an error, but the bar graph stating that my BPM spiked ABOVE 100 multiple times screams otherwise.

In any case, I've attempted to post the most relevant information down below as I'm not allowed to post attachments or provide links due to what someone explained as massive bot spam not long ago(if my account is registered soon, I'll see to updating my post with the proper link). I do apologize for the wall of text. I've done my research on attempting to understand the results, but as someone who is fresh out of the womb in this topic, I obviously have a lot to learn about what I'm seeing. For instance, I know what the acronyms stand for(or can easily google them need be), but what I don't understand is the relationship between the numbers.

On the actual results document, they boxed both RI* and ODI*, for being over the norm I assume. What could this indicate? I also realize that there are factors that the HST can't take into consideration, such as RERAs, RLS/PLM events, etc. How heavily would this effect the results I'm seeing here? Does anything on this results list indicate that there may be an underlying issue that the AHI can't account for?

Thank you.

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Impression:
1. No obstructive sleep apnea-hypopnea syndrome observed. This adequate study did not reveal the presence of clinically significant obstructive apneas or hypopneas. The apneathypopnea index (AHI) was normal at 4 events per hour; the minimum oxygen saturation was 81%.

2. Primary snoring: (Normal snoring without OSA cause? Doesn't attribute for the cruddy symptoms I'm having daily.)
3. Hypoxemia: (81%)


Here is a lovely list of my symptoms:

Irritability, Snoring, Daytime sleepiness, Restless sleep, Trouble Concentrating, Wake with dry mouth or sore throat(not constantly), Loss of Libido, Lack of energy, Witnessed Apneas, Fall asleep at inappropriate times, snoring, then silence followed by gasping(not constantly), daytime sleep attacks.
(For the ones that I'm not awake for, I have a witness, my significant other as explained above).

Analysis (Flow evaluation period: 7 h 0 min i Sp02 evaluation period: 8 h 59 min) (chart stuck me at a 4)

Indices:

AHI*: - 4.4
RI*: - 9.71
Apnea index: - 0.1
UAI: 0
OAI: 0.1
CAI: 0
MAI: 0
Hypopnea index: 4.3

% Flow lim. Br. without Sn (FL). 66
% Flow lim, Br. with Sn (FS): 0

ODI Oxygen Desaturation Index- 7.2
Average saturation: 91
Lowest desaturation: 81
Lowest saturation: 81
Baseline Saturation: 91

Minimum pulse: 51
Maximum pulse:145
Average pulse: 77

Result:

Average breaths per minute [bpm]: 21.20
Breaths: 8906

Apneas: 1
Unclassified apneas: 0 (0%)
Obstructive apneas. 1 (100%)
Central apneas: 0 (0%)
Mixed apneas O (0%)
Hypopneas: 30

Flow lim. Br. without Sn (FL): 5883
Flow lim. Br. with Sn (FS): 5

Snoring events: 456

No. of desaturations: 65
Saturation <= 90% : 211 min (39%)
Saturation <= 85% : 1 min (0%)
Saturation <= 80% : 0 min (0%)
Saturation <= 89% : 61 min (11%)
Saturation <= 88% 9 min (2%)

Proportion of probable CS epochs: 0 0%

[Julie]

Just curious what other labs etc. you've had recently, like a cardiac work-up, thyroid and glucose testing, etc.

[Pugsy]

About all you know is the HST says no OSA...doesn't say no problems.
That oxygen drop is a problem and caused by something.
Since it didn't screen for RERAs you don't know if you had them or not.

What did your HST consist of in terms of equipment attached to you?
We assume the standard finger tip pulse oximeter which does the oxygen levels.
Anything else? Chest belt? Cannula at the nostrils? Heart rate sensors?

[Rukel]

Just curious what other labs etc. you've had recently, like a cardiac work-up, thyroid and glucose testing, etc.

I haven't had any other workups yet. This was the beginning based on what was assumed and noted. I'm assuming that the results of this HST will have many more tests follow behind it. The next test I'm supposed to have scheduled is a liver ultrasound as my total enzymes was a little higher than the average. We also did a small lung capacity test, but I didn't get the results for those. The nurse did comment that my capacity was below average.

About all you know is the HST says no OSA...doesn't say no problems.
That oxygen drop is a problem and caused by something.
Since it didn't screen for RERAs you don't know if you had them or not.

What did your HST consist of in terms of equipment attached to you?
We assume the standard finger tip pulse oximeter which does the oxygen levels.
Anything else? Chest belt? Cannula at the nostrils? Heart rate sensors?

The HST used the ApneaLink Air. You can find a manual online. I'd link it but I don't have the rights. So I'll list what it covered:
The ApneaLink Air used a Oximeter, an Effort Sensor(I'm still not sure how this works as I don't see any effort based stats on the report), Nasal Cannula and the accessories to wear the system including a Belt, Oximeter Belt Clip, and a bag. The HST did indeed monitor the BPM, but I'm not sure if that's what you mean by the Heart Rate sensor. On the results document, there are graphs for both my BPM and the Saturation. I apologize for not being able to show you those.

i would not call that IHT negative at all

it may not have showed a high AHI but you dont need any of those to die from the problem
one LONG episode of not breathing will do it

When you say one long episode, what do you mean? Are you referring to the possibility of CA that can't be detected? Wouldn't that still show as an OA due to not breathing at all?

AHI does not account for much other than a guide to whether OA needs addressing
it does not help with all the other sleep problem nor low spO2 due to the bad statistics used to compute AHI

if your spO2 goes low that will drive the heart rate way up
mine went to 172 about 35 beats more than my alleged maximum

AHI isn't computed based just on the events that happen? I wasn't aware of this. I thought the index just measure the duration of sleep against the events that happened. What am I missing?

ODI is your oxygen desat index which you noted was low
RDI is respiratory disturbance index
Ri is respiratroy arousals a combination of apnea/hypopnea index (AHI) plus inspiratory flow limitation events
NOTE two books on apnea also use RI for resistance index and also Recurring Tonsilitis (go figure!)

RERA and PLM etc will make you tired but wont show up in measurements like AHI
certainly not on a home test although RDI would work as a surrogate

Why is it that insurance companies won't go by RI then? That seems like a more prominent indicator of whether there's a problem or not considering it takes two types of events into consideration.

low spO2 and bad sleep seem to be the cause of your complaints
breathing through the mouth could be part of the answer for the dryness
but mostly its not sleeping well which is at least partly caused by the RI/RDI which may be RERA based

what is making that spO2 go so low
you may need an xpap but insurance wont pay for it with a score of 4
even if it makes you feel good and improves QOL
so you may have to buy your own to feel better

I'm not sure why my oxygen saturation is dipping. But when it does, it's followed by a high BPM above 100. The HST doesn't seem to show any reason as to why it falls so far. I suppose I won't know until I schedule a lab study.

you need to start with a full physical with complete labs
and follow up with any specialists your doctor recommends

he needs to know about all medicine and other factors like stress, shift work, yada yada to help determine what the cause is

you may well need to see a board certified sleep doctor and have a full bore PSG to determine why you are not sleeping well
and to find out why your spO2 goes so low which is likely a quirk of the bad way they compute the AHI statistic

I think that's going to have to be the plan at this point. I haven't heard back from my primary doctor yet, but I should be hearing from them either tomorrow or sometime next week. If this is as bad as it looks, I'm assuming it's gonna be a lot more complicated than just OSA. I wanted confirmation on that being the case, and if that was, what type of issues it may be pointing to. I apologize for not being able to give all the information required!

[Pugsy]

I am familiar with ResMed's ApneaLink Home study. If I remember the "effort" thing is the belt around the chest to see if you don't breathe are you trying or not trying...not trying usually means a central so this study will flag centrals if I am remembering correctly.

The reason I asked was because I didn't know if you had a multi channel home study or just the pulse ox.
You had a multi channel test and the ApneaLink is a well respected test.

If you have someone saying "I saw you quit breathing last night for so and so length of time"...I would want an in lab study if it was me and I had those desats.

All that said...there's any number of problems a person could have just in the sleep disordered breathing category.
OSA is but one of a long listed of suspects.

You are going to need a further work up and discussion with your doctor about the oxygen levels. Something's causing the drop.

[Julie]

It's about time.

[Pugsy]

i see julie deleted my second reply too

You can rest assured it is NOT Julie deleting your posts...she doesn't have a spam button.

It's not me either.

Now whomever it is...only Carolyn knows.

[Guest]

i see julie deleted my second reply too

you will need to pm me for the answers
unless she deletes this one too so you cant see it

I don't have access to PMs at the moment. I should when my account is accepted in the future.

I am familiar with ResMed's ApneaLink Home study. If I remember the "effort" thing is the belt around the chest to see if you don't breathe are you trying or not trying...not trying usually means a central so this study will flag centrals if I am remembering correctly.

The reason I asked was because I didn't know if you had a multi channel home study or just the pulse ox.
You had a multi channel test and the ApneaLink is a well respected test.

If you have someone saying "I saw you quit breathing last night for so and so length of time"...I would want an in lab study if it was me and I had those desats.

All that said...there's any number of problems a person could have just in the sleep disordered breathing category.
OSA is but one of a long listed of suspects.

You are going to need a further work up and discussion with your doctor about the oxygen levels. Something's causing the drop.

I just looked into this an realized that the results document I have isn't the data I was expecting. They sent me a simple generated report without the raw data from the device itself. I kinda feel like I should have specified at this point. The report is missing all types of information that could provide insight to what might be happening. Whether or not I need an In Lab study, I don't have everything I need. If I were to ask and get the data I requested, would there be any software I could use to view it?

[Pugsy]

If I were to ask and get the data I requested, would there be any software I could use to view it?

I am sure there is software to read the raw data...that's probably where this report came from. Now maybe this report was dictated and not all the results were noted.
I have no idea where to find it though...don't even know what it might be called.

[LSAT]

i see julie deleted my second reply too

you will need to pm me for the answers
unless she deletes this one too so you cant see it

You are ASS uming again. There are dozens of members that realize that you are loco.

[Rukel]

If I were to ask and get the data I requested, would there be any software I could use to view it?

I am sure there is software to read the raw data...that's probably where this report came from. Now maybe this report was dictated and not all the results were noted.
I have no idea where to find it though...don't even know what it might be called.

I found a manual for the device that shows how to use both the software and the hardware. Software just seems to be called ApneaLink. The files created by the device are apparently just EDF+ format, which SleepyHead is apparently able to read. While I think I may be able to get the files, I'm not sure if I can use the software to view it or be absolutely sure that SleepyHead will be able to read the files either just because they're in EDF+ format. I've also read that the ApneaLink software needs the hardware to work. I'm still looking into it, but it might be a route I can take to gather more information. Of course, this is all being said without mentioning that the Software is *usually* only available to resellers and Drs. I could probably find it via alternative channels. No idea though.

As for the report, yeah, ApneaLink does generate it, automatically based on analysis settings at that. This may be a situation where the reports were generated, but were not verified by a sleep doctor as I was told just yet. I need to clarify this with the ST group.

[Pugsy]

SleepyHead won't be able to read the ApneaLink software. While the files may be in similar format ...there's a lot more involved than just one type of file. SleepyHead won't have any codes to tell it what to do with what it finds in the files.

[Pugsy]

the spam button is on the post
anybody can click it

julie admitted it in so many words

No, she didn't admit to it...she just clapped her hands in approval that someone removed it. Which BTW...I did too and laughed about it.

You see the spam button because you have one...she doesn't see a spam button because she doesn't have one.
So all the posts you see with the spam button showing...that's not what she sees.
She doesn't have a spam button...she lost hers a few months ago. I know that for a fact.

[Rukel]

SleepyHead won't be able to read the ApneaLink software. While the files may be in similar format ...there's a lot more involved than just one type of file. SleepyHead won't have any codes to tell it what to do with what it finds in the files.

Never that easy huh? I'll see about hunting down the official software online. It has to be somewhere. I appreciate you helping me out.

[kteague]

WTFI posted a long reply to the OPers follow up statements. Some libturd deleted it using the spam button.

I still see a long reply posted by you. Not sure what it was that got deleted.