A hypothetical question...

[derek]

Some of you may have read a post by me last night.

Here's a purely hypothetical question that I probably shouldn't ask, and don't expect any definitive answers to. I also am not thinking along these lines:

If, after a series of clinical tests, a medical professional informs a patient that he/she has a certain medical condition while knowing that the tests revealed that the patient did not have that condition, but actually had a much lesser but similar condition, thus scaring the daylights out of the patient, would that constitute malpractice?

derek
...who, as Wader said, has OSH -- b'gosh!!

[Liam1965]

I would say "yes", BUT... I'd be hesitant to call it that, just in case you missed a word.

For example, "You have apnea" would be wrong if you had hypopnea, but "You have a condition similar to apnea" would not be, and the patient likely walks away with "I have apnea".

Just my thoughts.

Liam, dispensing thoughts like Johnny Appleseed dispensed seeds.

[wading thru the muck!]

derek,

Medicine, being the inexact science that it is, unless the inacurrate diagnosis caused you any harm I think you would have a hard time asserting that it was malpractice (hypotheticaly, of course). Based on what you've said and how you seem to like this person outside of her sleep medicine expertice, I would have a sit down with her (hopefuly on her dime) and fill her in on the dangers of her gross simplification of your diagnosis. Tell her that in your professional opinion (and you definately have the stature to use such language with her) that she is risking harm to her patients by this practice and that as a friendly acquaintance you are taking this opportunity to give her this "heads up".

Thanks for sharing this story with us. It's very intriguing.

[Guest]

How would we know...go and see a freakin' lawyer!

[derek]

Since this is a hypothetical situation I won't expand or make any specific comments here. However. Wader, I said almost those very words to somebody yesterday.

Guest, I have no intention of going there!

[Guest]

Well, what in the heck does this have to do APNEA? How does your post and hypothetical question benefit anyone here, trying to deal with apnea or cpap use?

[Pohtaytoh]

I am generally the strong silent type and that's why my number of posts is as low as it is. But that doesn't mean I am inexperienced.

Derek, Wader said it best.

As for Guests...It is fine that you have your opinions, I have mine too. I think one of the biggest problems with our society today is there are too many sue happy people. They want to sue for everything. Give it a rest. Go to work and earn an honest living (or try the lotto!!!).

Later,
The 'Tater

[Liam1965]

Well, what in the heck does this have to do APNEA? How does your post and hypothetical question benefit anyone here, trying to deal with apnea or cpap use?

Why do you care so much? There is plenty of good information on this site, and a group of people who have started to respect each other's opinions such that occasionally questions are asked which are OT. Does it matter?

I've yet to see an honest-to-goodness Apnea or CPAP question go unanswered here, and if you don't allow for some OT discussions, the board would get very boring very quickly and there'd be nothing to keep the rested gals and the SWSs of the world sticking around to help the others.

By making it a community, open to some fun and frolic and some off topic discussion, it keeps everyone's interest, so when someone has a question which DOES relate, we're here and checking and can answer.

Oh, and let's be honest, just exactly how chicken hearted do you have to be to throw little barbs like this without registering, logging in, or identifying yourself in any way? At least when I make a post (informational, accusational or humorous), everyone knows who I am and has many ways to contact me if they don't like what I have to say. If you can't be bothered to identify yourself, you really can't be considered enough of a member of the community to have any real say in the matter (although of course anyone who wishes to join is certainly welcome).

For me, I'm getting quite sick of "guests" (whether it's the same one repeatedly, or several of you) jumping in here and telling a batch of people who seem quite content and happy with the way this board is going that they're not doing it right.

Liam, sick and tired of the self-appointed net police.

[Pohtaytoh]

Liam,
Couldn't have said it better myself. You da man!

[derek]

Gang,
Although it's not explicit in this thread, if you have read my prior post I think you might understand that it's not really off-topic.
As you are probably aware, we (or at least I) become hightly coupled to our CPAP therapy and even obsess about it (to our detriment). Today I am feeling confused and even betrayed, my crutch has been taken from me, and I'm a bit fearful of going back to those wretched nights. In this case the truth has not set me free...
I guess that in opening this thread I was seeking to assign blame for an uncomfortable situation.
derek

[Mikesus]

Gang,
Although it's not explicit in this thread, if you have read my prior post I think you might understand that it's not really off-topic.
As you are probably aware, we (or at least I) become hightly coupled to our CPAP therapy and even obsess about it (to our detriment). Today I am feeling confused and even betrayed, my crutch has been taken from me, and I'm a bit fearful of going back to those wretched nights. In this case the truth has not set me free...
I guess that in opening this thread I was seeking to assign blame for an uncomfortable situation.
derek

Derek, from what I read of your posts, you STILL had hypopnea events. While not as severe as apnea events, I would think that you could still suffer the same ill efects of having both hypopnea and apnea events.
You might have been misled, but I wouldn't feel betrayed. you yourself have said that you feel better with it, so what's the problem?

Mike who wished he didn't have hypopnea or apnea events

[day for night]

Derek,
Don't be too worried about terminology. You should be concerned about the effects. If you have hypopnea and have fragmented sleep from it, cpap will still probably work for you. I can't quite tell, but it sounds as if your cpap has been taken from you.

FYI, I'm in exactly the same boat. No apneas during my sleep test, but lots of hypopneas. I started cpap a few weeks ago. So far, it makes me feel worse, so I'm still waiting for some beneficial effect.

[wading thru the muck!]

derek,

Mike is right. The parameter used to judge the severity of our illness is AHI... Apnea Hypopnia Index. The absence of one ore the other does not affect the number we have. If you had an AHI of 4-14 and other symptoms like hypertension, daytime sleepyness, morning headaches etc... you are sufficiently inflicted for teatment. If you have an AHI greater than 14 you don't need any other symptoms. Where ever you fall into this range, you are still in it and wearing the hose every night is beneficial to you.

[Liam1965]

I'm also not sure OSH is all that different from OSA. I mean, to me, it's not a different disorder, only a different extent.

So the difference between hypopnea and apnea is not (imo) as great as the difference between an apnea patient who has 15 5 second apneas per hour vs one who has 60, 30 second apneas. The first loses a minute and a quarter of breathing per hour. The second, half an hour per hour. You lose no breathing entirely, but you wake yourself up nonetheless.

So yes, you (like me) don't suffer the anoxia and thus, the organ damage that someone who has the disease worse would suffer. But we still get the lack of proper REM sleep, because our bodies are jolted out of it in order to correct a breathing disorder.

I'm not dismissing your feelings, I'm just thinking you might want to look at it a different way: You're still having breathing events, and still need treatment. And untreated, your hypopneas could become full blown apneas in the future.

My two cents, since you asked.

Liam, who REMembers proper sleep. Once upon a time.

[Guest]

Derek, my impression is that sleep medicine has always been at odds regarding the best way to diagnostically categorize hypopnea exclusive patients. I experienced almost exclusively hypopneas during my PSG, yet I was given the diagnosis of "obstructive sleep apnea". My impression is that this informal diagnostic protocol arose from the early days when insurance carriers were less likely to cover the cost of CPAP for hypopnea exclusive patients. In those early days, hypopnea exclusivity was not as empirically understood by the medical and insurance industries as apnea exclusivity was. For better or worse, most hypopnea exclusive patients come away from their PSG with an "apnea" diagnosis to this day. Some take home UARS or RERA diagnoses depending on their airway physiology and diagnostic circumstances.

In the last couple of years I have noticed my own distribution of sleep events to slowly manifest a slightly lower ratio of hypopneas to apneas. Maybe an "OSA" diagnosis for us "hypopnea hose heads" is but a self-fullfilling prophecy of sorts!