Supplemental Oxygen: Two different oximetry Results

[Rlamb]

To whom it may concern:

Background: I am a 25 year-old female. Very healthy and even underweight by BMI. Division I athlete in College. Diagnosed with OSA in June 2011 and started a RESMED s9 Autoset in June. Nurse practicioner said I probably have it because I have a small mouth and a big tongue.

My questions relates to supplemental oxygen: I have been dreaming some more lately (which I always have until my resmed machine) and decided to get another oximetry test to see how effective my cpap was working. Before being diagnosed, my overnight study showed oxygen levels get as low as 70%. The oximetry company (which is seperate from the sleep lab I had the test with) called specifically to make sure that I had followed up with treatment because they were concerned about my low levels. I told them yes.

Well, I had to home oximetry test to measure the effectiveness and got a call back stating that I needed supplemental oxygen. However, my husband and I talked it over and asked for a second test before having to use an oxygen concentrator. I hadn't taped it on my finger like suggested, but did kept it on during the night. I just called back today and was told that this time I did not qualify for oxygen. They said that I was not under 88% at all.

Does anyone have ideas about why this would happen? Also, I'm going in tomorrow to get a copy of the results so I can see if my levels were near 88 at all. I'm thinking about buying a pulse oximeter to monitor myself. Sometimes I just feel like I should think more clearly and be up sooner in the day without being so cranky. In general, I've felt better but still feel there's room for improvement? Any feedback is greatly suggested.


I

[chunkyfrog]

I gather it was the oxygen company that contacted you?
Not sure you need oxygen if the lowest you went was 88%.
Others here know more than I, and if you need it but don't qualify, they may have some ideas.
Somebody may have a clue on your inconsistent results.
And yes, a recording oximeter is a very good idea.

[Rlamb]

I'm not positive who called. I just know it wasn't the people I got the study with. I think it was the oximetry company.

[jamiswolf]

Rlamb,
With two oximetry readings being so far apart, I would think you need a few more nights measured before any decisions are made.

And a few thoughts about your OSA. It seems very strange that a young healthy person should have such low O2 readings while on cpap therapy. I would question the efficiency of your therapy. Mask leaks or pressure settings too low (just off the top of my head) could cause apneas to be occurring despite therapy. Or you could also be having central apneas that aren't treated by a regular xpap machine. So you need to get aggressive monitoring your cpap data...and repeating those oximetry readings in an effort to sort things out.

Did you have any central apneas during your study? Get a copy if you don't have it.

A common sleep lab standard might be: Below 88% for two hours. Then O2 is needed...or something similar.

And if it turns out your O2 really is low...you should probably have a pulmonary consult just to be sure something isn't going on with your lungs.
J

[Rlamb]

jamiswolf

Thanks so much for your feedback! To clarify, the 70% desat was before my cpap treatment during my original overnight sleep study. That's when they said I have mild/moderate sleep apnea. I don't have the oximetry data for the last two oximeter studies, but I do have the original sleep study data. It says that I had 10 CA, 4 OA, and 0 MA, 95 Hyponeas, Total Events 109.

Then in the last month (7months into treatment), I was thinking I should get it checked to see how well or efficient the treatment was going. After that test they said I would need supplemental oxygen because I went under 88% for the amount of time they said was necessary. However, I didn't tape the oximeter on at night like they suggested. Maybe that's why? but I'm not positive. My husband and I both agreed that I should have another test before getting oxygen to make sure. The therapist informed me that I didn't go under 88%, but she tell me exactly what my results were. So I'm thinking I can go and get both copies from the doctor they faxed it to tomorrow. Now they are not ordering oxygen (which I'm kinda pleased about).

However, I was thinking with those original levels being so low I should buy an oximeter with data capability so that I can see what's going on myself and stop guessing.

[Slinky]

Its worth the $100-$150 to buy a recording oximeter to my way of thinking just to ease your mind whenever you have doubts or questions.

[jamiswolf]

Blamb wrote: It says that I had 10 CA, 4 OA, and 0 MA, 95 Hyponeas, Total Events 109.

Over what time frame was that? They usually list total minutes of sleep. Did the data list an AHI?

I'm just a little worried that the central apneas have gotten out of control.

So get the software to read your data card on your cpap machine. Most people around here use Sleepyhead which is a free download. And you said you wanted to get a pulse ox. Good idea both.

I don't know why those two readings were different. Or maybe they weren't and they were just interpreted differently. Those were two different nights and probably with two different oximeters. In the future, ask for a copy of any tests you have. You're sort of flying blind w/o data.

Nothing sounds like an emergency...you just need more info to evaluate things.
J

[Pugsy]

How about starting with some basic information that would help the members have a better idea what might be going on? The ResMed S9 Autoset is a full data machine and there is easily obtained and used software to help you get an idea what short of events might be happening during the night and how long they are lasting.

SleepyHead is free and very easy to use. I have information on it in my signature line.
Please read the User Guide also. Once you have your detailed reports in front of you could you post one of the typical daily detailed reports for the forum members to see??..so they have a better idea what might be going on with your therapy. See if something jumps out needing some work or additional thoughts.

If you don't know how to post one of your reports..here is how I do it.. screen shots are easiest and quickest.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

Once you do this you will have several reports available...this one is an example of mine from the other night...this one is more helpful than the summary graphs because this shows hour by hour.

[Rlamb]

Thanks for all the responses. I'll work on getting that information together and downloading sleepyhead. And see if I can scan the info into my computer. Probably take till next week. I'll re-post then for more info. sometime next week.

Rlamb

[Rlamb]

Here's my resmed data from the first oximetry test to see how well the cpap was working. Keep in mind, my results for the oximetry showed "excess artifacts" but that I qualified for oxygen. I'm waiting to get my results from the study where I didn't go under 88%. That night I taped the pulse oximeter on my finger. I'm hoping once I get a pulse oximeter it will show pretty good numbers.







My original sleep study gave the following information:
Sleep stages : Total Sleep Time
n 1 (stage 1) = 32.9%
n2 (stage 2) = 27.8%
n3 (stage 3 &4) = 24.3%
R (REM) = 15%
W (wake) = 13.4%
Body Position Data
Position Time in Position AHI/hr
up 7.7 0.0
supine 176.8 21.7
supine/right 43.5 12.8
supine/left 0.3 0.0
right side 39.7 17.8
left side 121.0 15.9
prone
prone/right
prone/left
Respiratory events summary
Category CA OA MA Sum Apnea Hypopneas Events
Number 10 4 0 14 95 109
Max (sec) 14.5 24.0 0.0 24.0 27.0 27.0
Mean (sec) 11.9 14.1 0.0 12.6 14.0 13.8
Tot time (min) 2.0 0.9 0.0 2.9 22.2 25.1
% of TST 0.6 0.3 0.0 0.8 6.3 7.1
Index (#/h TST) 1.7 0.7 0.0 2.4 16.2 18.6

Apnea and Hypopnea Index
REM #/h (REM) NREM #/h (NREM) TST #/h (sleep)
AHI 4.5 21.0 18.6

Oximetry Data (I didn't put the <90, <85, <80 ect. because it was pretty low 0.4 min, 0.4 min, 0.4 min, 0.4 min; all less than 0.11% of TST)

Average O2 while awake 98 Average O2 while in NREM 97
Average O2 while in REM 96 minimum O2 value 89
Oximetry Distribution WK REM NREM TOTAL % TST
Desat index (#/hr) 5.7 13.4 12.3
Duration desat/hr min 3.4 min 8.0 min 7.3 min
Desat max 0% 4% 8% 8%
Desat max duration 0.0 sec 55 sec 174.5 sec 174.5 sec

Ok, in general looking through sleepyhead it seems all/majority of obstructive apneas are gone and centrals are the only thing left. The numbers are usually 0-1.5 AHI caused by central.

please let me know what you guys think after seeing the data.

Rlamb

[jamiswolf]

Rlamb,
Your AHI numbers are excellent. But the few events you're having are centrals.

Either those centrals are real whoppers...or you need to see a Pulmonologist. Do you know what your O2 is like during the day?

Even though you were an athlete in College...any shortness of breath now?

Overnight oximetry (and spot checks during the day) will shed much light on the situation.
Jamis

[Rlamb]

Jamiswolf,

My aunt has an oximeter for spot checking. The only time I've checked it, it was above 97% or something like that. It was pretty high. I haven't ever really checked it during the day on my own. No shortness of breath (what would that feel like exactly?). In general I breath pretty slow.

Question: what did you mean by the centrals are whoppers? and that I should see a pulmonologist? I just need a little understanding.

Thank you so much for looking through the info with me!
Rlamb

[Rlamb]

Anyone is open to comment please!

[deltadave]

You need to get as detailed a report as you can.

If they just ran the report instead of reviewing and removing artifact, which would result in spurious data, you could end up with erroneous results.

What sport were you in?

[Rlamb]

Division I Soccer. And i was the best in shape of everone during my career. I also ran x-country and high school.