Does a sleep study HAVE to show AHI greater than 5 to warrant cpap use?

[Pugsy]

So...here you go guys...a place to "discuss" the merits of what the medical profession has come up with in terms of a line in the sand for earning the diagnosis of OSA....that all powerful 5.0 AHI line...or even 15.0 in some parts of the world to get some form of insurance coverage as some insurance require a higher AHI depending on insurance requirements.

Is it a hard line or a soft gray line???

This thread
https://www.cpaptalk.com/viewtopic/t183 ... d-264.html
is on the fast track of derailment with some very strong personal feelings about said line in the sand and it's getting a bit ugly and not particularly helpful anymore.
I don't like that sort of derailment in newbie threads.

So duke it out here please and NOT in a newbie thread if you just HAVE to duke it out.

[Pugsy]

So...my own personal thoughts as to the line in the sand of 5.0.

I say it depends....it depends on some answers to some additional questions I might want to be a factor in my own advice.
Have we ruled out some potential other culprits as being a potential cause for whatever unwanted symptoms someone might be having???

Can a relatively low AHI ...per a sleep study of some sort...still indicate the presence of some sort of sleep disordered breathing disorder that might be causing the unwanted symptoms? It wouldn't be impossible.
1...might depend on the type of sleep study done...home study vs in a lab and if home study the actual kind of sleep study done in terms of data collected. With any sleep study the results are going to depend on actual sleep obtained.
If someone doesn't get good solid blocks of sleep then the test results aren't really indicative of the entire situation and could point to a false negative. Happens all the time.
2...also remember that the criteria for flagging of events could potentially lend to the impression that nothing meets the line in the sand criteria when in fact physically it could still be very important. Remembering that apnea events have to meet the 10 second duration criteria first. Think about it for a minute...what if you have 15 apnea events per hour average that only last 9 seconds???? Those won't be included in that AHI total but do you really think that just because an event only lasts 9 seconds that it has zero impact on the person's sleep quality just because of that 1 second???
3...remember that poor sleep quality can mean less than normal REM stage sleep where OSA can be much worse.
A person can have a not so remarkable AHI in non REM sleep and a kick ass severe AHI in REM...and if during the sleep study a person doesn't get much, if any, REM it might appear that there is no OSA of significance going on where in fact there is severe OSA going on. I fall into this category myself and it was indeed a difficult diagnosis for me and I had an in lab sleep study where I simply didn't get much sleep in general and even less REM stage sleep.

So I am not going to automatically pooh pooh off a sleep study result with a lower than 5.0 AHI and tell someone that cpap isn't indicated without trying to factor in more information as to what encompassed that not so exciting AHI.
I want more information before I tell them cpap won't help. That's why I always ask a bunch of nosy questions before I offer that opinion. There are simply too many other variables involved.

[MMcG]

I'm in broad agreement, Pugsy, but it seems likely that a sleep study with an AHI of 2-3 for a relatively young, physically fit man, suggests the reasons for chronic daytime tiredness lie elsewhere. OK, maybe it was a home sleep study which underestimated the AHI somewhat, but I only responded to the facts presented. You've asked good questions and maybe the OP's answers will offer some enlightenment. BTW I sent a private message to him apologising for causing his thread to go off topic, even though I don't think I was really responsible for that. And, in case you missed my last reply to Palerider, Resmed states quite clearly on its website that an AHI of less than 5 is "considered normal" (their words, not mine) and doesn't warrant CPAP therapy.

[Morbius]

I think I'd have to look and see the raw data. You're assuming the machine is accurate, and IMO, with such few events, most oftenly it's not.

[MMcG]

I think I'd have to look and see the raw data. You're assuming the machine is accurate, and IMO, with such few events, most oftenly it's not.

We don't know whether it was a lab or home sleep study, but it wasn't from a CPAP machine, based on what the original poster said. Sleep studies done in sleep labs are usually fairly conclusive and reliable to the best of my knowledge, while home ones can underestimate the result (because they cannot tell for sure whether the person is awake or asleep during the period of the study). When it comes to CPAP machine results (the ones usually posted here), one has to be aware that not all machines are programmed the same way when it comes to recording and responding to events. For example, on my Devilbiss/Intellipap machine, the clinician menu allows one to redefine Hypopneas and Obstructive Apneas, both in terms of duration and percentage obstruction.

[MMcG]

I think I'd have to look and see the raw data. You're assuming the machine is accurate, and IMO, with such few events, most oftenly it's not.

We don't know whether it was a lab or home sleep study, but it wasn't from a CPAP machine, based on what the original poster said. Sleep studies done in sleep labs are usually fairly conclusive and reliable to the best of my knowledge, while home ones can underestimate the result (because they cannot tell for sure whether the person is awake or asleep during the period of the study). Regardless, the OP is unlikely to be able to get the "raw data" or breath-by-breath analysis from a sleep study, based on personal experience anyway.

When it comes to CPAP machine results (the ones usually posted here), one has to be aware that not all machines are programmed the same way when it comes to flagging and responding to events. For example, on my Devilbiss/Intellipap machine, the clinician menu allows one to redefine Hypopneas and Obstructive Apneas, both in terms of duration and percentage obstruction.

[Pugsy]

It always takes more than one person to take a thread sideways. Always.

The OP in that thread...hasn't logged in at all after the original post. No answers to some needed and important questions.
Unknown as to why but all original thoughts were appropriate IMHO.
People get to have differing opinions...and people get to disagree with said opinions...people get to be rather passionate about their opinions as well.

Just because someone is

relatively young, physically fit man,

and has a low AHI doesn't necessarily mean really all that much because there is so much we don't know.
Age and fitness really has absolutely nothing to do with what sleep disordered breathing can do to a person despite the typical stereotyping.

IMHO the correct response would be to try to glean additional information before going on a tirade about the likelihood of OSA being a cause or not for unwanted symptoms.
That's why some questions were asked by myself and others....we really need more information before taking a hard line on things. You took a hard line based on one number and no other information and dug yourself deep into the trenches without taking into account other potential factors. IMHO...that was premature on your part.

Bear in mind that most likely the OP isn't here in the US...most likely in the UK somewhere and they do things differently over there. He already has received a prescription for a cpap....I assume from a doctor privately since the UK health system won't dispense cpap machines unless certain criteria is met.
So he is under someone's care privately and there's a real good chance that the usual culprits for extreme fatigue have already been ruled out...or should have been....hence the need for more information.
What we assume is that his doctor probably has said something like "we don't know the cause of your problem but cpap might help so here's the RX...go buy a machine and give it a go and see if it helps".
OP came here essentially wondering if it was worth spending the money and the real correct answer is that there is really no way to know based on what little information we were given but the fact that he has a RX in hand...speaks volumes.
Now we don't know for sure that his doctor has already ruled out potential culprits but we assume it has been done because doctors in the UK don't go prescribing cpap without a good reason when sleep studies don't document the need per criteria.

UARS was mentioned and in the UK they just don't test for UARS all that much and it is a very real probability and it can cause horrible symptoms and it very well could be the root of the OP's problem. We just don't know but cpap is the first thing offered for UARS treatment.

So you and I assume different things....you assumed that nothing else was ever done to rule out culprits for the fatigue and tell the guy that cpap won't help. You don't know that for sure because you don't have enough information to make that statement. You weren't given enough information by the OP.
I assume that some addition detective work was done by the doctor who prescribed the cpap machine because I know that in the UK doctors don't go giving those prescriptions willy nilly...but I tried with some questions to glean additional information and probably would have had additional questions after I got some answers to my first questions. I don't normally start asking a gazillion questions right off the bat because I have learned that I am lucky to get answers to maybe 3 questions at most. People rarely answer all the questions I might ask if the list is more than 3. Hell, sometimes I ask 3 questions and get only one answer. Annoys the hell out of me.

I always look at medication side effects first so that's why that question is usually my first question.
And I don't assume that because someone is "young and fit" that they aren't on medications that might cause fatigue or they aren't having some other physical or mental issue going on that might be a cause for the meds or even just a cause for the fatigue.

There can be any number of reasons why someone might have a rather unremarkable AHI (below 5) but that doesn't mean that what they are experiencing is "normal"...and while it might be considered "normal" to have a few apnea events here and there by the medical profession per the line in the sand standards...that doesn't necessarily mean that someone isn't having airway issues of some sort enough to cause the unwanted symptoms.

It's just plain wrong to make a blanket statement that "your AHI is less than 5.0 and cpap won't help and you need to look elsewhere for causes of your unwanted symptoms" when all we know is "my sleep study(s) only showed 2 or 3 AHI.
Now once we had answers to a lot more questions....we might qualify our responses by adding maybe "unlikely" or "not usually" or something like that.

Any number all by itself really doesn't mean much except in this instance it doesn't meet established criteria to meet diagnosis requirements. That's really all it means. Doesn't take into account the chance of UARS being a factor...doesn't take into account that we don't know what kind of sleep study was done...doesn't take into account if the person even slept much during that sleep study....doesn't take into account any number of things that could have impacted a lot of things.

Just because the medical profession has drawn the line in the sand at 5.0...that doesn't mean that 3.0 can't be a significant problem in terms of sleep quality...
Do you really think that having your sleep disturbed times an hour or every 12 minutes is that much different than an AHI of 3.0 or every 20 minutes is going to be THAT different. Hell, we don't know what happens with that after that 20 minute arousal...maybe the person has trouble going back to sleep and they are awake for another 15 minutes and overall sleep quality is in the toilet because of those 3 flagged events (never mind any 9 second events that aren't part of the record).

See what I am getting at???? We just can't make blanket statements like you made based on a single number that we really don't have a lot of information as to how that number was even obtained or how reliable it might be.

Palerider has a LOT of experience with OSA personally along with his brother's history which was significant and complicated.
Palerider feels like total crap even if his AHI is 3.0 on cpap...it's important to him because he knows first hand that AHI of 3.0 can significantly impact how he feels.
We all tend to base our advice here on everything from out own personal experience. It's just the nature of us here whether it is about what mask is best or whether to use exhale relief or ramp or whatever. We draw from our personal experience along with a lot of reading. I do the same thing myself.
So Palerider is going to tell someone that "you have a RX...get a machine and give it ago..I know I feel like crap with 3.0 AHI even now..so it might help and worth trying".
I see AHI 3.0 all the time and I can't tell any difference between an AHI night of 1.0 and 5.0...so I am not so quick in that regard. 2 different personal experiences and 2 different thoughts to offer. There is really no right or wrong...we are only going with our own opinions based on our own personal experiences....it's really all we can offer because our crystal balls are broken and we can't see the future.

So....your original thoughts of "cpap won't help because 3.0 AHI is normal" was really premature and incomplete.
You really didn't have enough information to make that statement so definitively (and certainly not worth the pissing contest that followed between yourself and PR) and you failed to factor in the potential for UARS involvement...and you assumed that the OP had not already had some sort of work up to rule out other causes of the fatigue. We don't know that...for all we know he could have had a gazillion blood tests or whatever and the cpap RX the doc gave him was a throwing crap against the wall to see if something stuck because the doc was out of ideas.

Since the OP's original question was about spending the money ...and all the prior needed questions had already been asked so no need for PR to repeat those questions...PR offered the idea to just try cpap and see if it helped or not because remember...cpap is first line of defense for UARS as well. He just addressed the one thing that hadn't been addressed by prior comments. Nothing wrong with that or his response to the OP. It is a viable option...after all the OP's doctor had already given him a RX for cpap so he must have also thought it was a viable option.

All this fighting over the medical line in the sand of 5.0....waste of time and band width and waste of energy because we simply don't know enough in this situation to fight about it. All it does is muddy up the waters and raise people's blood pressure.

IMHO a more appropriate response would be to say something like "your AHI is below the 5.0 line in the sand for OSA causing significant symptoms" "has your doctor ruled out other conditions that might be causing fatigue" "UARS could very well be a factor but since cpap is the first thing they tell people to try for UARS...it is worth considering since you have a RX already"...
All that instead of tunnel visioning what is "normal" or not because remember a number by itself without any other information is just a number that doesn't mean a whole lot.
It's rarely that simple.

We don't know what kind of sleep study...how comprehensive it was...or hell...even if the person actually slept.

[MMcG]

I'm done with commenting here anyway, Pugsy. So I reckon everyone will be happier. I honestly don't need the aggro. Peace.

[Pugsy]

Why is it that when people disagree with someone instead of just saying "I guess we will just have to politely agree to disagree" they have to go storm off in a huff and "I am outta here" but they don't ever really leave or they threaten to "not post anymore" or they say "you prove I was wrong" then get pissed off when someone does?

God...people disagree with me all the time.
If I took it personal I would be driving myself crazier than I am already.

Hey Morbius...good to see you again.
We don't have the raw data of any sort...and in fact we don't have much of anything.
All we know is someone probably in the UK apparently had some sort of sleep study X2 and the AHI wasn't diagnostic (2.xx and 3.xx) and the question was "should I spend a boatload of money for CPAP....there was some mention of maybe UARS"...
That's all we know. The OP in question has been a one visit wonder and doesn't appear to have returned and for sure not answered any questions that might help us with more concrete ideas.
He left and hasn't been logged in since initial first post.

Original topic was becoming a pissing contest so I wanted further pissing to be done here and not in the OP's thread...which probably is/was wasted effort on my part. Since I have my doubts as to whether or not that guy will ever be back.

[Morbius]

Why is it that when people disagree with someone instead of just saying "I guess we will just have to politely agree to disagree" they have to go storm off in a huff and "I am outta here" but they don't ever really leave or they threaten to "not post anymore" or they say "you prove I was wrong" then get pissed off when someone does?

Because they're a 2 year old?

[Morbius]

Sleep studies done in sleep labs are usually fairly conclusive and reliable to the best of my knowledge...

Y'know, I've heard that!!

[Morbius]

We don't know what kind of sleep study...how comprehensive it was...or hell...even if the person actually slept.

I hear ya.

Maybe he's got Covid.

[chunkyfrog]

Five is only a number.
It has been used for way too long to have the same meaning now as it did then.
We don't even know where it originated--or from whose tuchus it was pulled.
Too long ago to matter.
Every patient is different--too many other variables to put everything on a digit.

[zonker]

This thread
https://www.cpaptalk.com/posting.php?mo ... 1&t=183755

interesting. when i click that link, it takes forever to load. then it only offers me a chance to reply, not read the thread.

as to ahi of five, i have absolutely no opinion. it didn't happen to me, so i don't have a vested interest. i just like to hear from folks here who have KNOWLEDGEABLE experience on the matter. so will continue to read about it when it presents itself.

there's more to say, but i don't wanna derail THIS thread, so will keep schtum.

[Pugsy]

interesting. when i click that link, it takes forever to load. then it only offers me a chance to reply, not read the thread.

Well that was weird.
I think I fixed that little boo boo.