spo2 low of 82

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
puzzled
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spo2 low of 82

Post by puzzled » Thu May 21, 2015 11:53 pm

hello everyone, I am new here. I have a concern, and maybe some of you can help me. Finally got the GP to order an at home sleep study for my mom. I have
noticed several times that i thought she would stop breathing. Well had the study done, NO obstructive sleep apena is all the nurse could say, well I had them
forward the report to me, that is when I become concerned. Her mean sao2 was 91, and her lowest reading was 82%, this concerned me. Her ahi was only 2.4
Doing reading, i think supplemental oxygen would be called for, and the sleep study doctor mentioned hypoxia in the report, but nobody seems to know
what to do. She is overweight, but does not have any lung problems.
Talking to the medical supplier, the rule for medicare is 4 minutes at 88% or less. This must be documented. My conclusion was wouldn't the sleep apena
study have recorded this info in this detail? The supplier said they thought it would, but nobody seems to want to say so. I guess the other option
is to do a sao2 study.....but the same device is used for it !!!!!!!!!!
Nobody seems concerned. She is tired, doesn't feel good, and is fuzzy in the mornings, but nobody seem to pick up on this. I've called the GP office to
see if there was a plan, and nobody returned the call.
From what I have read, i believe she would benefit from 2L thru the night. A basic new concentrator, low flow of 5 L or less is available for about 600
but locally, over 1900......and still need an rx for both.

any ideas ?
Last edited by puzzled on Tue May 26, 2015 10:03 pm, edited 1 time in total.

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kaiasgram
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Re: sao2 low of 82

Post by kaiasgram » Fri May 22, 2015 12:10 am

The sleep center/hospital would normally not forward the full sleep study (all the "raw" files) to the patient or referring doctor, however if you (or your doctor) request it you should be able to get it. A few forum members have managed to get their whole sleep study so that they can have another professional review it. You might want to retitle your thread something like "How do I obtain full sleep study?" so someone who knows more about how to do this will spot it and help you out.

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Julie
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Re: sao2 low of 82

Post by Julie » Fri May 22, 2015 3:42 am

Her SAO2 may be low for many reasons (how recently has she had comprehensive labwork and/or other tests for other possible problems?) but your speculation about her needing 02 based on just your quickie personal research with (I presume) no medical training is quite a leap. Please do your mother a favor and get more real med advice before deciding on your own that 02 is the answer. She's already been told there's no apnea, though what else they may or may not have learned is not given here.

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49er
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Re: sao2 low of 82

Post by 49er » Fri May 22, 2015 3:47 am

Hi Puzzled,

I would be concerned about the low O2 also even if it just briefly went down to 82%. I would keep politely calling the GP's office to get an answer about that and see if they agree with you about supplemental O2 being called for. And if they don't, make sure they adequately explain their reasoning.

49er
puzzled wrote:hello everyone, I am new here. I have a concern, and maybe some of you can help me. Finally got the GP to order an at home sleep study for my mom. I have
noticed several times that i thought she would stop breathing. Well had the study done, NO obstructive sleep apena is all the nurse could say, well I had them
forward the report to me, that is when I become concerned. Her mean sao2 was 91, and her lowest reading was 82%, this concerned me. Her ahi was only 2.4
Doing reading, i think supplemental oxygen would be called for, and the sleep study doctor mentioned hypoxia in the report, but nobody seems to know
what to do. She is overweight, but does not have any lung problems.
Talking to the medical supplier, the rule for medicare is 4 minutes at 88% or less. This must be documented. My conclusion was wouldn't the sleep apena
study have recorded this info in this detail? The supplier said they thought it would, but nobody seems to want to say so. I guess the other option
is to do a sao2 study.....but the same device is used for it !!!!!!!!!!
Nobody seems concerned. She is tired, doesn't feel good, and is fuzzy in the mornings, but nobody seem to pick up on this. I've called the GP office to
see if there was a plan, and nobody returned the call.
From what I have read, i believe she would benefit from 2L thru the night. A basic new concentrator, low flow of 5 L or less is available for about 600
but locally, over 1900......and still need an rx for both.

any ideas ?

puzzled
Posts: 17
Joined: Thu May 21, 2015 11:39 pm

Re: sao2 low of 82

Post by puzzled » Fri May 22, 2015 10:54 am

Have looked into this closer. Contacted the RT department at the hospital that did the study. They found her study and looked at it, and she was at 87% for
several hours, and then dropped off the cliff at 82% for about half an hour. The person that read the sleep study, said it was not obstructive sleep apena,
which the data showed correct, but also noted that she was hypoxemia. Since nobody saw the raw data, that showed this info, nothing was said anywhere.
Everyone is in agreement that she needs supplemental O2 durning sleep. The problem is, medicare requires some sort of "proof", it is difficult to extract
the sao2 data from the report, and we can not get a answer if that is good enough for medicare. GP nurse called and said if they can get that data/proof/report
to document that, he will right the rx that day (or the PA will if he will not).
But, if that does not fly, may need to do an overnight sao2 study, that will be specific, and make medicare happy.
But one question tho that was brought up, they are not sure what to make the rx out of flow. The "usual" is 2L, but the question is, if at some time she does
fall may, additional flow would be needed. The RT and DME supplier can't think of a automatic variable flow oxygen system that is for home use. If she was
connected to a cpap/bipap it could adjust the pressure and etc, but not the concentration, but the sleep study does not show she needs cpap !!!

Anyone else run into this type of situation, and what was the final treatment used ?

thank you !

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HanzT
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Re: sao2 low of 82

Post by HanzT » Fri May 22, 2015 11:49 am

If this was my mom, I would make an appointment and take her back to the doctor. You can't usually get much done on the phone from my experience. Odd that the sleep study isn't good enough. Maybe if you meet with the doc it will be.

puzzled
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Re: sao2 low of 82

Post by puzzled » Fri May 22, 2015 2:34 pm

Another update. The RT department and the DME supplier called. The talked to medicare, and medicare can not accept the sao2 data from a sleep study to
justify supplemental oxygen durning sleep. So, the next step is to do an overnight sao2 study. Equipment is ready, just need to have the dr write an
rx for the study, and fax it back. Everyone is somewhat surprised that medicare would not accept the data from a sleep study that they approve !!

so, need to get the order, then do study, it is emailed off to the "independent lab" that will read it, and give the data, and recommendation to our GP, who
in turn will make a written order or supplemental o2 durning sleep.

anyone else have this kind of fun ??

thank you

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palerider
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Re: sao2 low of 82

Post by palerider » Fri May 22, 2015 2:37 pm

puzzled wrote: sao2 data sao2 study.
it probably doesn't matter, but SaO2 requires a blood draw. SpO2 is what you get with a finger sensor.

that said, when a friend of mine had low SpO2 on cpap, we just bought a concentrator off craigslist. it was *much* faster than trying to slog through the medical system.

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puzzled
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Re: sao2 low of 82

Post by puzzled » Tue May 26, 2015 12:12 am

i stand corrected. the spo2 is the "indirect" measurement, most commonly found by our little finger units.

thank you, pale rider

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palerider
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Re: sao2 low of 82

Post by palerider » Tue May 26, 2015 9:34 am

puzzled wrote:i stand corrected. the spo2 is the "indirect" measurement, most commonly found by our little finger units.

thank you, pale rider
I mention it only because it might cause confusion somewhere if you're using the wrong term, and the less confusion at this point, the better.

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JohnBFisher
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Re: sao2 low of 82

Post by JohnBFisher » Tue May 26, 2015 6:38 pm

Yeah, I've had both SpO2 and SaO2 studies done. As you note, SpO2 is the clamp over the finger. It does okay, but really does not accurately measure what's getting to the extremities. The SaO2 study is done by drawing blood from an artery in the wrist. OUCH!!

You mention your mother is overweight. It's possible she's suffering from Obesity Hypo-ventilation Syndrome (OHS):

http://www.nlm.nih.gov/medlineplus/ency ... 000085.htm

Sometimes doctor's don't want to explore options. It's also possible the slight hypoventilation (due to excess weight) is triggering CSA (central sleep apnea). Those events can often be overlooked by these home sleep studies.

Just a few possible angles to consider.

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puzzled
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Re: sao2 low of 82

Post by puzzled » Tue May 26, 2015 10:02 pm

john. Rather interesting suggestion. As background. Due to some edema, and a need to get into some shape for some possible surgery, it was decided to get
in the best shape we can. One thought was CHF. So an ECHO was done, it revealed the ejection fraction was good (in the 60's) but noted the left atrium
was enlarged. since she is not hypertensive, which is one of the typical causes of the condtions, we were sent to see a cardio. In the meantime, urged
sleep study, since reading material said OSA could also lead to that. Came back with no OSA (ahi as either 2 or 3), but the desaturation.
In the meantime apointment made with cardiologist, saw him today, he was not excited about the enlarged atrium, not much could be done other than
eliminate things which could be a cause, such as loose weight, get blood sugar under control. Then he brought up sleep apena if she was tested, we
said yes, but test showed she did not have OSA, but was concerned on the o2 levels. He said that also could be causing it, but if not, it wasn't good
anyhow, but did mention that the weight could be causing the OSA on occasion, and sometimes heavy people just don't get as much air, and that
could be the problem.

Our problem is, they are backed up almost 2 months to get a sleep study, my theory is just get a o2 concentrator, run about 2 liters, not going to
hurt anything. Maybe in those 2 months on 02 treatment, might help alot of things.

puzzled
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Re: spo2 low of 82

Post by puzzled » Wed May 27, 2015 7:01 pm



Did more checking today. Clinic has data, doc needs to look over to order spo2 test, but he's going to be gone for a while !!!!!

So I callled around. These supply places are nuts. I've picked out three units that i would consider. I priced them locally then on
the internet......Locally, double or tripple !!!!


One 5L unit, on the internet somewhere around $700..........locallly $4500 !!!!!
most others were simular.

Then the thing that gets you going.........why would you want to buy one when medicare will pay for it ????????

Our problem is getting the script. I was told by everyone they just need a "pad rx" if you pay yourself. I thought, well just call one of those online
doctor outfits. Everyone is thinking 2L o2, which would be very rare to be harmful to anyone (except copd people who's drive is based on co2)

i called three places, asked if their doctors could write an rx of oxygen.........ahhhh dahhhh.....i don't know, we'll just have to set you up an appointment
and doc will decided if you need oxygen.......it will be $70 to do so, when do you want the appointment ?

we know we do, but the people running the gate have no clue.

The cardiologist said the sooner the o2 issue is addressed the better. The heart is very dependent on oxygen.

anyone else have experience using "internet doctor services", for oxygen, sleep apena, etc ?

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palerider
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Re: spo2 low of 82

Post by palerider » Wed May 27, 2015 7:20 pm

puzzled wrote:anyone else have experience using "internet doctor services", for oxygen, sleep apena, etc ?
not really, when a friend needed o2 due to low spo2 at night with cpap, I just went with craigslist and picked up a machine the next day. the newer ones have o2 purity monitors in them, so you can tell they're working.

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puzzled
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Re: spo2 low of 82

Post by puzzled » Mon Jun 01, 2015 8:43 pm

After jumping thru some hoops, got the "raw" sleep data......tell me if I should be pushing to get thngs done:
ahi 3.0 odi 2.5 snore index 2.8%

apena/yupopnea index 3hr
apena index 1.3/hr
hypopnea index 1.7/hr
snore index 2.8%
flow limitation index 8.8%
longest apena 21s
longest hypopnea 88s

total apenas 11
obstructive 9
mixed 0
central 2
hypopneas 15
average apnea 14s
average hypopnea 33s

desaturation index 2.5/h
desaturation count 22
lowest spo2 82%
average spo2 91.1%
baseline spo2 91.2 %
desaturation <90% 2.4/hr
desaturation < 85% .6/hr
sp02 time <90% 6.1%
spo2 time < 85% 0.1%

rough count on graphs looks like about 7 minutes or more per night under 88%
almost 40 minutes a night under 90%

so, am i unreasonable asking for 2L supplemental o2 at night ?????