Oxygen while waiting for your equipment: Good idea?

[quote="Slinky"]Good point, RG! I ran into an opposite situation that still bolsters the use of an overnight oximeter test when on CPAP if you had significant desats. My sleep pulmo was confident based on my titration that CPAP alone would be sufficient for me desats. When I was still having problems 3 months after starting CPAP I pushed a bit for an overnight oximetry. Turns out I did end up needing 2L of 02 supplementing my CPAP. That wouldn't be the case for everyone, of course, But ... if one has significant desats it isn't a bad idea to have an overnight oximetry run whilst on CPAP w/room air and/or CPAP and 02 supplementation.

Right O., there's a pile of different things here. But back to our story...

Snoredog wrote:

StillAnotherGuest wrote:For OSA, not a good idea, especially if therapy is done arbitrarily and unmonitored. It'll probably make the REM apneas worse.

then why do some people here have supplemental oxygen added with their CPAP?

That wasn't the question. The question was

RosemaryB wrote:Since people have to wait so long for everything after this first sleep test, why not prescribe oxygen while they are waiting. If they have significant desats, it only seems to make sense.

Specifically, nasal oxygen is not recommended as prrimary treatment for OSA, temporarily or otherwise, under the current Standard of Practice:



If one WAS going to provide interim treatment, it would generally make more sense to use a 2 pound APAP rather than a 52 pound oxygen concentrator.

Depending on the insurance, the oxygen might not even be allowed (some insurers will NOT pay for oxygen if OSA desats can be addressed with CPAP).

But to generalize and say

Snoredog wrote:you have to weigh the good from the bad, can't see it doing any harm.

Is not true. The patients being suggested to receive arbitrary supplemental oxygen here (the ones with the most significant disease) are the ones most likely to end up with catastrophic result with unmonitored therapy:

The well-known phenomena of acute respiratory failure induced by supplemental oxygen may have precipitated this respiratory arrest in this patient. Oxygen at the level provided was certainly sufficient to induce hypoventilation in patients with chronic obstructive lung disease and the typical polysomnogram findings would be hypopneas as well as central apneas, which were reported. Based upon the information provided, it appears more likely the respiratory arrest in this individual was due to supplemental oxygen inducing respiratory acidosis and eventual arrest rather than obstructive sleep apnea playing a direct role.(in Neurology Obstructive sleep apnea associated with cerebral hypoxemia and death 23 June 2004.)

And in other news

Allen Patrick ran for 145 yards and two TDs, Sam Bradford threw two long touchdown passes to Juaquin Iglesias and Oklahoma outraced Tulsa 62-21 Friday night.

Boomer Sooner!!

Now if my Mets can just keep it together for another week, then all will be right in the world.
SAG

RosemaryB wrote:Since people have to wait so long for everything after this first sleep test, why not prescribe oxygen while they are waiting.

I don't see why they don't prescribe an autopap why waiting....

StillAnotherGuest wrote:If one WAS going to provide interim treatment, it would generally make more sense to use a 2 pound APAP rather than a 52 pound oxygen concentrator.

Agree.

jskinner wrote:I don't see why they don't prescribe an autopap why waiting....

I know what you mean, James.

Cynical me can think of at least one reason why they don't:

Most "sleep doctors" have another specialty that's far more important to them than "sleep." Many are pulmonologists. They're likely a lot more familiar with prescribing O2 than with prescribing (or understanding) "autopap." They do what comes to mind first -- O2 too low when they sleep? Give 'em O2 while they wait.

I'm not sure if it even occurs to most of them that the O2 just might not be able to squeeze past the obstructives. They've done a very medical kind of thing...prescribed supplemental O2... "Next..."

Also, I think a lot of doctors (yeah, even some sleep doctors) don't really take sleep apnea as seriously as they should. Low O2... they're used to taking that seriously. Bring on the O2!

The little cpap machine? Oh, that can wait. We gotta get this O2 going first. Right now. Today.

rested gal wrote:

StillAnotherGuest wrote:If one WAS going to provide interim treatment, it would generally make more sense to use a 2 pound APAP rather than a 52 pound oxygen concentrator.

Agree.

jskinner wrote:I don't see why they don't prescribe an autopap why waiting....

I know what you mean, James.

Cynical me can think of at least one reason why they don't:

Most "sleep doctors" have another specialty that's far more important to them than "sleep." Many are pulmonologists. They're likely a lot more familiar with prescribing O2 than with prescribing (or understanding) "autopap." They do what comes to mind first -- O2 too low when they sleep? Give 'em O2 while they wait.

I'm not sure if it even occurs to most of them that the O2 just might not be able to squeeze past the obstructives. They've done a very medical kind of thing...prescribed supplemental O2... "Next..."

Also, I think a lot of doctors (yeah, even some sleep doctors) don't really take sleep apnea as seriously as they should. Low O2... they're used to taking that seriously. Bring on the O2!

The little cpap machine? Oh, that can wait. We gotta get this O2 going first. Right now. Today.

Somebody needs to report them pulmonologists to quack watch!! what do they know about prescribing oxygen anyway

And I agree it would be a whole lot easier just to give them a machine (any machine) set at 10 cm, but I bet there is another reason they put them on oxygen and it wasn't any worry about apnea in REM, like many with severe OSA they are probably not getting any deep or REM sleep anyway.

As luck would have it, here's a sample of an OSA patient being treated with supplemental oxygen only. The O2 saturation line should be straight across at about the 95% level. In the first graph, with no oxygen, an incredible about of repeating desaturations:



Addition of supplemental oxygen shows at least 2 areas where the desaturations have become even worse. These are probably REM periods (EEG not monitored, oximetry only).



Now again, the question was

RosemaryB wrote:Since people have to wait so long for everything after this first sleep test, why not prescribe oxygen while they are waiting. If they have significant desats, it only seems to make sense.

If the oximetry looks like #1 above in a PSG that is screaming OSA with REM dependency, then O2 is not indicated.

If, however, Rosemary's friend has a total baseline drop, then that might be another matter, there's probably something else underfoot.
SAG