Cease CPAP Use Two Weeks before Sleep Study?

[Wulfman...]

Where's Dave aka Morbius aka Rubicon now...when we need him?
He reads or has read a lot more studies than I have ever thought about reading.

I've been wondering that for a long time. He was a very valued contributor back in the day.

I can understand a brief cessation (maybe a few nights) but there should be a reasonable limit.

Den

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[Wulfman...]

After visiting this thread again, a contradiction occurred to me.
If I'm already using XPAP therapy with a data-capable machine, why in the Hell would I need an in-lab sleep study when I'm already getting one (an in-home study) EVERY NIGHT??? Other than if something went completely haywire with my existing therapy (maybe Cheyne Stokes respiration or some other condition caused by a health-related event), I can't think of any valid reason.

Den

[SleepGeek]

I second that...

Ultimately it was 6 nights without the machine and I actually now have a cold, the first one since before covid.
You’re right I shouldn’t have gotten a study.

Was it a study or a titration? I tend to think the way you felt after ceasing the cpap use would be enuff to prove that your OSA didn't magically disappear.

You confirm my feelings that I have had fewer colds since using cpap.

[chunkyfrog]

Redundant sleep studies are a cash cow for the labs and anybody receiving their kickbacks.

[lazarus]

Apples and oranges and common sense . . .

Apple: Someone with long-standing life-threatening severe OSA who has zero reason to believe it is now suddenly miraculously gone. Orange: Someone barely and briefly near the 5 AHI line who now has significantly changed circumstances that a sleep doc considers worthy of a retest to see about complete cessation of PAP. The two don't belong in the same discussion. Hardly ever.

The severe-OSA patient has no bidness sleepin' for five minutes without being tubed and masked up. Ever. For safety. On the other hand, the barely maybe-not-apneic-at-all-now patient has no reason to use PAP for the weeks before a study to "prove" no benefit from (or reason for) PAP, if that's the idea.

The reason to be off PAP for a while to "prove" no need for it is the residual effect of upper airway pressure and zero snoring causing a lessening of the swelling in the upper airway. For some, testing during the residual-effect time period proves nothing about long-term safety of being off PAP. It can take weeks for the fluid and swelling [edit: that is caused by failure to use PAP] to get back to prePAP levels. This is in the realm of theory and research docs, naturally, since no one in his or her right mind would have any reason to test that across a population. It is a rare bird to sight in the first place.

But if the goal is to find out what someone's AHI is likely to be while being off PAP in the long term, it only makes sense not to test for that near some recent PAP use, since the residual effect of PAP could, in theory, in some, throw off the accuracy of what you would be testing for.

Back to my grave.

Zombie out.

[dataq1]

Apples and oranges and common sense . . .

Apple: Someone with long-standing life-threatening severe OSA who has zero reason to believe it is now suddenly miraculously gone. Orange: Someone barely and briefly near the 5 AHI line who now has significantly changed circumstances that a sleep doc considers worthy of a retest to see about complete cessation of PAP. The two don't belong in the same discussion. Hardly ever.

Indeed !
The appropriate answer to the question of retesting and if therapy ought be withheld prior is : It depends

It depends on the patient (and their current status, it depends on the objective purpose of the retest, it depends on the standards for retest, and there could be others "depends"

All I've been trying to suggest (over 3 different threads) is that the resolution of these conditionals is best made between the doctor and the patient.

Doctor and patient need to discuss the reason for the retest, a hiatus (if any). The patient and doctor should come to an agreement, to do that requires discussion.

[dataq1]

why would I need an in-lab sleep study when I'm already getting one (an in-home study) EVERY NIGHT???

Because the "study" you are getting every night (your OSCAR data) is not representative of a "without therapy support" study.
Furthermore, your nightly OSCAR data likely does not include respiratory effort observations or brain wave activity.

[southerndoc]

I cannot comprehend why this makes sense. It's similar to a cardiologist asking that a patient have their pacemaker turned off prior to an interrogation to see if their underlying rhythm still needs a pacemaker. (Yes, the pacemaker is turned off during the interrogation, but not a week before.)

You've already established you have OSA. Isn't the goal for subsequent studies to titrate for better treatment instead of confirming that you have OSA? One would think you would want to see how well current treatment is doing and go from there.

I'll ask my wife (a former RPSGT) when she gets back home. Curious if this was common practice for the pulmonology office where she used to work.

[Dog Slobber]

Because the "study" you are getting every night (your OSCAR data) is not representative of a "without therapy support" study.
Furthermore, your nightly OSCAR data likely does not include respiratory effort observations or brain wave activity.

Kind of like how your posts don't demonstrate much brain wave activity, so you keep posting.

[ChicagoGranny]

the study that she referred to where it was insinuated that prior cpap usage could affect the outcome of a sleep study for up to 2 weeks post discontinuing cpap.

The study did not insinuate that a washout period was needed to prevent ongoing CPAP usage from affecting the AHI in a sleep study. The study described only the downstream effects, e.g., cardio- and cerebrovascular events, carried over from CPAP use. It did not make any conclusions about AHI (apnea) except to say "returns rapidly."

Downstream effects, such as "a deterioration of daytime symptoms and psychomotor performance; increases in blood pressure, heart rate, and urinary catecholamines; peripheral endothelial dysfunction; disturbances of cardiac repolarisation; and changes in the metabolic breath profile", were being studied, and it was noted they might not return as rapidly as apnea (AHI).

[ChicagoGranny]

in theory

Did you just blow up your own tome?

[lazarus]

in theory

Did you just blow up your own tome?

Of course. Wishy-washy is my primary editorial style.

It isn't a common enough situation to have meaningful literature, in my opinion. But there IS solid enough evidence to the approach.

I think most thoughtful sleep docs (both of them) would likely do everything within their power to ensure enough of a chance for obtaining objective proof of likely benefit from continued PAP. That would mean letting the state of the upper airway deteriorate from [edit: discontinuing the benefits gained from] continuous PAP use before a diagnostic NPSG.

[ChicagoGranny]

I wish Bazooka made the old size pieces in unsugared plus xylitol.

[lazarus]

I wish Bazooka made the old size pieces in unsugared plus xylitol.

Please stay on topic in your own threads.

[Bons]

I have to have a new diagnostic study tonight via home study. My new doctor recommended going one night without my bipap before tonight’s test in case of residual splinting of my airway.