Opinion on sleep SpO2 levels

[icantbreathe]

Dear friends,

I would like to ask your opinion regarding my sleep SpO2 chart below. This is a typical chart I have been having for a couple months now.

Clinical context is onset in recent months of mental confusion, headaches and feeling like drowning all day and night.

Bird's eye view clinical context is probable ALS diagnosis since 2018. I have history of a pulmonary embolism in February 2019. I had Covid 5 months ago, treated at home. Never had cough or associated dyspnea.

Recent blood work show D-dimers in good levels and chest CT scan didn't show blood clots.

I am obviously looking for a Pneumologist at this point for proper diagnosis and guidance, with possible blood Co2 tests, but would like to ask this community's experienced members opinion regarding the severity of the abnormality of what this chart hints to.

Could this be OSA, or does does it look like it could be all attributable to my worsening ALS? The aggravation of my well being occurred over the last 2 months after weeks of intense relationship toxic stress, and didn't resolve after cessation of stress, by the contrary, it just kept worsening. As explained, blood clots were ruled out.

My BMI is 33, I'm male 43 years old. My FVC is around 70-75% and I'm highly sedentary due to ALS stiffness. Have a plant based diet.

Thank you so much for your time and valuable opinion,
Kindly,
John

[ChicagoGranny]

It's nearly impossible to diagnose OSA with only an SPO2 study.

[Julie]

And unfortunately only your doctor has other information on your ALS that would be necessary to even begin guessing at answers. No one here should even think about doing that.

[raisedfist]

You need an in-lab sleepy study that monitors both oxygen saturation and carbon dioxide levels. You probably have some sort of sleep-disordered breathing, based on your SpO2 chart, and it's something you should show your doctor(s). The chart just shows a problem, it can't tell us what it is.

[HoseCrusher]

John, It looks like you are almost on an hourly schedule. You drift off to sleep then your O2 levels drop and you arouse and roll a little then fall back to sleep. Rinse and repeat.

Your O2 is going lower than what is considered "normal".

There are many causes of O2 drops, one of them is OSA. It sounds like it is time to get a sleep study and take another look at this. When you visit with your doctor be sure to bring this data. Your doctor may not be interested but then again it may help figure out what is going on.

Forced Vital Capacity is usually the measure used to evaluate ALS but there does seem to be a correlation between desaturations below 90% at night and a reduction in FVC. This is a discussion to have with your doctor.

Another thing you can look at is what your daytime O2 levels look like. There is a lot of "noise" associated with daytime monitoring, but after a few days you can generally come up with an idea if the desaturations are also happening during the day.

The people I know that have ALS end up with desaturations day and night and that leads to using a CPAP machine all the time. OSA on the other hand generally involves desaturations at night and no issues during the day.

Good luck in figuring all of this out. If I can help in anyway, let me know.

[SleepGeek]

Dear John,
Finding a pulmonologist who is also a sleep doctor is a wise choice. I have seen several diff sleep docs and my all time fav is the pulmonologist. If you share your location I bet someone here will know one in your area. I say that cuz there are a lot of slack docs who pretend to practice in sleep medicine.

Come back and let us know how you make out.

[ChicagoGranny]

An AASM accredited sleep practice in any area can be found here - http://sleepeducation.org/find-a-facility

[mper!?]

John, It looks like you are almost on an hourly schedule. You drift off to sleep then your O2 levels drop and you arouse and roll a little then fall back to sleep. Rinse and repeat.

Hi, all

_ well, it does not cost me much this speculation: It has called my attention your about-1hr periodicity on oxigen drops, and rather more persistent during later hours. Could we speculate this would correspond to REM/atony stages, more flow restriction as usual for so many, and then, respiratory drawabacks due to OSA or Hypopneas?

all the best

[HoseCrusher]

mper!?, that is a possibility...

but to confirm or reject that idea more data is needed and that comes from a proper sleep test.