WatchPat sleep study Question

[ChicagoGranny]

So I had to look up actigraphy, (are we talking about the same thing? ) ' actigraphy measures gross motor activity and light for a week or so to determine cycles of activity' and used to evaluate interruptions of circadian rhythm'

By "arterial tone" , do you mean the responsiveness of the arteries to sympathetic nervous system? (fight or flight type reactions?)

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... The WatchPAT (peripheral arterial tonometry; WP) technology is a viable alternative to PSG for confirmation of clinically suspected sleep apnea15 that is based on peripheral arterial tone signal’s amplitude and rate, oxygen saturation and actigraphy. The WP provides accurate sleep/wake and REM/NREM discrimination together with non-REM categorization into deep and light sleep.16–18 In addition, the WP provides accurate measurements of snoring and body position. It has recently been shown to be able to distinct obstructive from central sleep apnea.

The WP device has been shown to be accurate for the diagnosis of sleep apnea; ...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721305/

what were the results? She has yet to get any results (test was done Dec 10)

Maybe you want to update this thread once the results are known.

[RobbyM684]

3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG)
https://aasm.org/aasm-releases-position ... a-testing/

I presume that the recommendation cited is couched in an understanding that there already existing SYMPTOMATIC basis for suspecting OSA*. (otherwise, as it stands, a negative 'single home sleep apnea test' , calls for the more extensive PSG)

I guess the thing that is troubling me is that home sleep study tests that used to be done with a nasal cannula, effort belt, and a pulse-ox (an apparently satisfactory system) are being replaced with something new that makes no effort at measuring air flow).

Is "pAHI" identical/synonymous to "AHI" ?

* without going into a lot of personal detail: wife is 79 years old, has arthritic spine and knees (and the accompanying pain), has worked on her feet for 52 years, raised 4 children and gets up twice nightly (HCTZ for kidney stones)..... she has every right to be tired/fatigued and not have the same energy she had at 39. That said, if she really has a OSA problem, I'd want her to be treated (but she may not like it). So the recommendation you cited sounds like " well lets keep testing until we can find a reason to prescribe Cpap" (regardless of symptoms)

[RobbyM684]

Maybe you want to update this thread once the results are known.

Sure will, but the thing that AASM recommends seems to suggest...... 'keep testing till we get a positive test' !
That really bugs me.

Meanwhile any thoughts on the "tone" and "motion" questions?

[lazarus]

the recommendation you cited sounds like " well lets keep testing until we can find a reason to prescribe Cpap" (regardless of symptoms)

Symptom presentation does play a real role, as informed by results of physical examination and family history and medical history. Thus the benefit of a trained sleep doc to oversee and judge the need for testing or retesting. Response to therapy itself can also be part of the overall diagnostic result.

But a proper PSG can also indicate a very low likelihood of significant medical sleep issues, mostly ruling them out. The point is that it is the only test that can be considered (by the AASM, anyway) as medical-science evidence that PAP is likely not needed.

That does not discredit HST, though. A test that indicates you will benefit is very valuable indeed.

[palerider]

2. A home study can (a) indicate you are likely to benefit from PAP. However, it is UNABLE to indicate that you are unlikely to benefit from PAP. It is also unable to screen for or rule out some related sleep disorders.

You shouldn't make blanket statements about "home study(s)" because there are three different types, the type 4 doesn't give you much, type 3 gives you more, and a type 2 gives you the majority of what you get from type 1 (in lab) study, principally lacking the person watching you sleep.

[lazarus]

2. A home study can (a) indicate you are likely to benefit from PAP. However, it is UNABLE to indicate that you are unlikely to benefit from PAP. It is also unable to screen for or rule out some related sleep disorders.

You shouldn't make blanket statements about "home study(s)" because there are three different types, the type 4 doesn't give you much, type 3 gives you more, and a type 2 gives you the majority of what you get from type 1 (in lab) study, principally lacking the person watching you sleep.

I stand by my statements on HST, even for Type 2. Although I concede that I may misunderstand the AASM's position statements and the article's statements that I quoted earlier in this thread. My understanding is that a negative or inconclusive Type 2 should still be followed by in-lab rather than allowed to stand as the final word. Has that changed?:

"Because of limitations in the specificity of HSAT to rule out OSA, a negative HSAT should be followed by in-lab PSG if clinical concerns for OSA remain (eg, if sleep-related symptoms persist and the HSAT does not identify OSA)."--Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement -- Sean M. Caples, DO, MS, W. McDowell Anderson, MD, Karel Calero, MD, Michael Howell, MD, Sarah D. Hashmi, MPH, MSc, MBBS / Published Online: June 1, 2021 --
https://jcsm.aasm.org/doi/10.5664/jcsm.9240

Does that postition of the AASM somehow not apply to Type 2 but the AASM failed to say so there?

Seems pretty clear to me.

So I'll stop lumping them together in my position when the AASM stops lumping them together in theirs.

But thanks.

[palerider]

2. A home study can (a) indicate you are likely to benefit from PAP. However, it is UNABLE to indicate that you are unlikely to benefit from PAP. It is also unable to screen for or rule out some related sleep disorders.

You shouldn't make blanket statements about "home study(s)" because there are three different types, the type 4 doesn't give you much, type 3 gives you more, and a type 2 gives you the majority of what you get from type 1 (in lab) study, principally lacking the person watching you sleep.

I stand by my statements on HST, even for Type 2. Although I concede that I may misunderstand the AASM's position statements and the article's statements that I quoted earlier in this thread. My understanding is that a negative or inconclusive Type 2 should still be followed by in-lab rather than allowed to stand as the final word. Has that changed?:

The problem is that false negatives happen in in-lab studies too, for any number of reasons.

I've seen reports from plenty of people who had an in-lab study, and came out with the report of not having sleep apnea, yet still having "(if sleep-related symptoms persist and the [study] does not identify OSA)" symptoms.

[lazarus]

I agree that no test of sleep is considered to have perfect sensitivity and perfect specificity for all sleep disorders, including sleep-breathing disorders. No one-night snapshot can provide that. But I continue to look to and to champion the AASM, rather than payors or manufacturers, for defining both the sufficient and the ideal standards for care.

[dataq1]

Is "pAHI" identical/synonymous to "AHI" ?

Interesting question. If they were identical why would they have two different names?

[lazarus]

Any measurement is useful if a doc can use it as evidence to convince a payor that someone should be allowed to trial PAP.

[dataq1]

Any measurement is useful if a doc can use it as evidence to convince a payor that someone should be allowed to trial PAP.

Perhaps a better way to express my question: Is "pAHI" and "AHI" clinically the same thing? Put another way, could everywhere AASM mentions "AHI" be replaced with "pAHI"?

The crux is: Apneas and Hyponeas are measured events, the criteria for those events are delineated by AASM. Are there similar criteria (by AASM) for the components of pAHI ?

[Jlfinkels]

Perhaps a better way to express my question: Is "pAHI" and "AHI" clinically the same thing? Put another way, could everywhere AASM mentions "AHI" be replaced with "pAHI"?

The crux is: Apneas and Hyponeas are measured events, the criteria for those events are delineated by AASM. Are there similar criteria (by AASM) for the components of pAHI ?

pAHI is AHI as measured by a PAT device.

https://jcsm.aasm.org/doi/10.5664/jcsm.3356

[lazarus]

The AASM does not own the concepts of "apnea," "hypopnea," or "AHI."

In-lab AHI is the gold standard. But any report of an "AHI" outside the lab is an estimate based on proprietary methods and definitions, including, for example, as is the case with any"AHI" reported by home treatment machines.

Data from home-treatment machines are designed for trending and don't need to be anywhere near as accurate as PSG. Similarly HST reports of "AHI" will/may not be as accurate as in-lab PSG, but will/may be plenty good enough for qualifying someone to trial PAP.

Brands differ in how they define and tabulate AHI. That's fine. I give extra credit to someone adding a letter to differentiate from in-lab PSG AHI. But usually you just use context to infer relative meaning of AHI in that specific context without letting that obvious difference confuse you.

[Janknitz]

Miss Emerita said

I'm especially concerned because as far as I know, the entire Kaiser health system uses WatchPAT as the test of choice.

Although Kaiser uses the WatchPat for the majority of diagnosing sleep apnea, I understand it will do an in-lab test if the results are negative but the symptoms still indicate an issue. And when the symptoms indicate other sleep disorders, they will do an in-lab study as well. For people who needed DOT testing, a chest strap was added to the test kit to measure respiratory effort (this was many years ago, I'm not sure they still do).

As the vast majority of people with sleep disordered breathing issues have obstructive sleep apnea, it makes sense to rule that in or out first, and I'm guessing the number of false negatives with this device is fairly low when users are screened for symptoms and risk factors first. If the WatchPat isn't entirely accurate on severity, it only truly matters on the low end when making a decision to treat or not, whether a person has moderate or severe OSA they still need CPAP, and then the question becomes whether CPAP is adequately treating the OSA regardless of severity.

I have said this several times and will say it again. If Kaiser had not offered me the WatchPat home test, I would be yet undiagnosed and probably dead. I had absolutely NO intention of doing an in lab sleep test, that is very intrusive and uncomfortable for me, and I can't see that it would have yielded accurate results given that I would have been so stressed by the process that I doubt I would have slept. I most certainly have some PTSD from heart surgery when I was 8 and have a very low tolerance for medical procedures and tests. A simple EKG (much easier than the days of the little squeeze bulbs and ice cold metal plates straps) bothers me, being hooked up to all those wires and expected to sleep in a strange bed with people watching me was NOT going to happen.

One Kaiser clinic can process perhaps as many as 50 people a week for testing with the Watch Pat, which I would suspect would result in MORE people being diagnosed and treated rather than fewer when a typical sleep clinic might be able to process 2 - 4 people per night at a much higher cost per person--the devotion of an entire night to the process, usually on a weekday. As always, Kaiser plays a numbers game. If they capture the majority of people with OSA who need treatment, they consider that a win.

When most people complain about the WatchPat, they are trying to convince themselves that the results are falsely positive because of denial, not science. How many times have we seen anybody come here and complain that they were denied CPAP treatment because the WatchPat didn't indicate a treatable number of obstructions???

Certainly WatchPat won't find things like RERA's, restless leg syndrome, PLMD, and may not catch when an apnea is more complex than simple OSA. A good clinician should be able to recognize when an in-lab test is warranted, or lack of success with treatment certainly indicates further study.

I'm not a Kaiser cheerleader. There are many criticisms I could offer about their system. But I think using the WatchPat as a baseline screening for OSA makes a lot of sense. And I don't think it's inferior to an in lab study for the vast majority of people who need to be tested for OSA.

So RobbyM684, please let us know how the test came out for your wife. Do you agree with the diagnosis (or ruling it out) and severity from what you observe beside your wife every night?

[RobbyM684]

Still waiting to hear from the pulmonogist/sleep doctor that she (the dr.) has gotten any results. Somewhat surprised as I anticipate that the WatchPAT would have been scored by machine, then sent to the Dr.

Anyways, still waiting to hear from the Dr to get an appointment to "receive" the results.

As far as my observations ("sleeping" beside her every night), she never snores, and actually seems to have a slow, steady, and quiet breathing, perhaps even shallow. I have never observed her to stop breathing (something that I, as a current cpaper, am sensitive to), but then I don't stay up all night watching and listening.

I will be surprised if she is scored above 5, and actually shocked if scored above 15. But we will see.