AHI under 5 acceptable; really?

[D.H.]

Supposedly an AHI under 5 is acceptable. For instance an AHI of 4.9 implies an incident on the average of approximately every 12½ minutes!

Can this really be healthy?

[Lucyhere]

Apparently there are doctors who seem to think a AHI of 5 is okay. However, most people don't feel their best unless their AHI is under 2.

[D.H.]

Apparently there are doctors who seem to think a AHI of 5 is okay. However, most people don't feel their best unless their AHI is under 2.

I know when mine went able 2, I felt like I'd been hit by a truck! My baseline was 52, but that was back in 1999. Since starting, I missed nights only because of power failures and overnight flights.

[JDS74]

By adjusting the pressures on my PR 750 Auto BiPap, I could get my AHI routinely under 2.0 and still felt lousy.

Titrated for an ASV machine and, even when the numbers are above 5.0, I feel better. The PR960 ASV and now the DS900 ASV vary from 2.0 to 7.0 but my quality of sleep is better.
The difference is the number of incipient CAs that are intercepted and never get to an actual CA - just a single breath long but the machine switches to ventilator mode and immediately switches back when I start to breathe again.

So, while for insurance purposes, under 5.0 is considered to be 'treated', that doesn't mean that you are getting good sleep. It really depends on both the frequency and the duration of the apnea events you experience and whether or not they result in an arousal that disturbs your sleep.

[jipavl]

I found this Mild Obstructive Sleep Apnea Syndrome Should Not Be Treated

Basically it states that for moderate OSA CPAP treatment has no confirmed benefits.

[BTS]

I found this Mild Obstructive Sleep Apnea Syndrome Should Not Be Treated

Basically it states that for moderate OSA CPAP treatment has no confirmed benefits.

This is from over a decade ago ..

Article information
J Clin Sleep Med. 2007 Apr 15; 3(3): 263–264.
PMCID: PMC2564770
PMID: 17561592

[Arlene1963]

I'm not one of those who feels a huge difference between an AHI of say 3 and 1. I really can't tell. What I do know is that using CPAP every night, all night when sleeping has completely changed my life and my sleep quality, and I am so very grateful. Also, having read so much about sleep apnea in last few years I've become aware that it is not as simple as a number, but is unique for each of us. Some people think they are sleeping absolutely wonderfully with severe OSA, and others have the mildest apnea and feel wretched.

[chunkyfrog]

Insurance companies usually accept even higher levels as NOT requiring treatment.
See the Medicare guidelines . . .
They really do not give a flyspeck..
Judging by the "surveys", there are few in the industry who care to hear what REALLY works.

[palerider]

I found this Mild Obstructive Sleep Apnea Syndrome Should Not Be Treated

Basically it states that for moderate OSA CPAP treatment has no confirmed benefits.

The hazards of cherrypicking old opinion pieces...

What you found wasn't a study, it was someone's opinion piece -- "I conclude that first line treatment" -- over a decade old, and disputed...

"Of note, our results showing that there is an increased risk of CKD even in patients with mild OSA may be of particular importance, as there has been disagreement regarding treatment for patients with mild OSA [47, 48]. Thus, our result may present a different perspective on the clinical management of patients with OSA." -- https://www.ncbi.nlm.nih.gov/pmc/articl ... 4098/#CR48

[jnk...]

No one breathes perfectly during sleep, but the payers ain't gonna pay for everyone on the planet to get a machine. So, based on research, clinicians had to agree on some way to define who gets to try a machine. Thus the diagnostic criteria were agreed upon that sleepy people with an AHI above 5 get to try a machine and people with a high AHI get to try a machine even if they aren't sleepy. Everyone pretends that OSA is a simply defined condition that you either have or you don't have. That isn't true, but we have to pretend it is true for the convenience of being able to call it a medical condition and have it fit in with how medicine is practiced today. The deeper truth of the matter is simply that some people benefit from PAP and some people don't, and the definitions for figuring that out are just tools to be used to help people, not documented scientific discoveries of magical breathing numbers. Once you have a machine, the idea is to get AHI as low as possible, but no lower. The treatment process is not directly related to the diagnostic process of qualifying to try a machine, so the number 5 is meaningless at that point.

One does not have to prove that PAP somehow miraculously cures every ailment on the planet in order to know that helping people sleep better saves lives.