Bad Information from Dr? Opinions Appreciated.

[VABeach]

I recently went to my Dr. for my 1ST check-in since starting APAP 9 months ago. The reason for the visit was simply to see how I was doing on APAP, compliance and a review of my data card. I was not at all happy with the visit as I was seen by a new Dr. who started the appointment by telling me what the acronym CPAP stood for. She did not like my VERY sarcastic reply that I knew what that meant. Things went downhill from there. She proceeded to download only the last 30 days of data and gave me the report for the 30 days. I asked her for a detail of each day and she responded that the 30 day summary was all that she needed and that the daily info would not provide me with anything more.

The biggest “red flag” was when the Dr. said that the AHI was not as important as the AI component. My AHI has averaged 2.8, and my AI has averaged 0.6. She said that my AI of 0.6 was the important number and that if I was below 5.0 on the AI value, that was well below normal and therefore good. Needless to say, I will not be going back except to get any need Rx.

Has anyone ever heard that AI was the really important number and AHI and HI were not?

Thanks in advance for your reply.

[Emilia]

I suppose it would depend on your sleep study results. I had a total of 78 events; 77 were hypopneas. My AHI was 17. My daily data from my machine rarely shows an apnea, but hypopneas do still occur so for me the HI and AHI are more important. Dismissing hypopneas, IMO, is doing a disservice to the patient. A more important question is how is your O2 levels during the night? If you are having apnease and/or hypopneas and desats, that needs to be addressed. My dx came about due to an overnight oximetry test that showed my O2 plummeted during sleep. Then the sleep study showed I bottomed out at 76% O2 and only had 2% REM sleep. Now I take my oximetry readings periodically with a CMS50E oximeter to be sure my therapy is not only providing me with good sleep, low HI and AHI readings, but that I am being oxygenated properly. My AHI has averaged 1.5 over the last 45 days with several days below 1. My oximetry reports show excellent O2 levels all night long with nothing below 88%.

If you had a lot of apneas along with hypopneas then I would be concerned about all the results.... and I'd invest in a data capable oximeter like the CMS50E or one of their other models.

[SleepyT]

Hey, I'll wade in with my opinion! It's worth what you paid for it....right?! Ok. Could be the doc only needs compliance information and therefore is not interested in hypopneas...only that the total blockages are below a certain number. However, IMO, if you have enough hypopneas strung together...it's still a very bad thing as far as suffocation goes...and it plays into how you feel every day!

See...I think you need another doctor too...and the reason is you need someone sensitive to how you are thriving...not a doctor only concerned with the math.

My two cents.

[Breathe Jimbo]

Young doctors can be the worst if they are insecure about their experience and competence.

Find a way to check your own data. Do you have the software?

[OutaSync]

Maybe the Dr. was talking about your case only. Since your total AHI was only 2.8, the AI of .6 is the more important number and since the total is well below normal, you don't need to worry at all about the HI.

I'm sure he would feel differently about the HI if your total AHI was 80 with an HI of 79, for example.

[LoQ]

The biggest “red flag” was when the Dr. said that the AHI was not as important as the AI component. My AHI has averaged 2.8, and my AI has averaged 0.6. She said that my AI of 0.6 was the important number and that if I was below 5.0 on the AI value, that was well below normal and therefore good. Needless to say, I will not be going back except to get any need Rx.

Has anyone ever heard that AI was the really important number and AHI and HI were not?

Yes. This is a very common misconception. The truth of your health cannot be boiled down to a single number. Even if your AI was only 4, would you find it accpetable if looking deeper you found that you were ceasing to breathe for 2 minutes straight 4 times an hour throughout the night? Of course not.

No one can say whether the HI for you is important. A good orthogonal check is to ask for overnight oximetry. But even that doesn't give you a picture of things like arousals, which can result in poor quality of sleep, even if you don't desat.

How are you feeling? That is yet another check on the effectiveness of your treatment.

Don't rely on a single measure of sleep quality.

[jonquiljo]

Find a way to check your own data. Do you have the software?

I agree! Get some software if you don't already have it and take care of monitoring yourself. That doesn't mean stopping your Dr visits- but rather guide your therapy by your hands.

Did this Dr. even ask you "how do you feel?" If not, get rid of her and find another. 5.0 on the AHI scale is not normal - its been chosen as the number above which you supposedly have a problem. LoQ pointed out quite nicely how "lower" AI's or AHI's are potentially not optimal.

Most of all - you paid for a service with the Dr. visit. You are paying the Dr. to help you. If they don't then - you are not getting what you are paying for. Just because insurance (in many cases) pays for the bulk of costs, who do you think directly or indirectly pays for insurance? You. So dump them and find someone who is worth your time and money.

Sorry your experience was so dismissive. It's hard enough to sleep with all this stuff and not get a reasonable answer when you ask to get follow-up. The software is really only a guide, but it's the best guide available. Good luck.

[rested gal]

the Dr. said that the AHI was not as important as the AI component. My AHI has averaged 2.8, and my AI has averaged 0.6. She said that my AI of 0.6 was the important number and that if I was below 5.0 on the AI value, that was well below normal and therefore good.

----

Has anyone ever heard that AI was the really important number and AHI and HI were not?

Thanks in advance for your reply.

Your equipment profile shows you're using a ResMed S8 machine. I personally agree with the doctor that the AI component alone is the important number to look at when using a ResMed S8 machine.

Here's why I think that way (I could be very wrong, of course.) Bear in mind that my posts back then were about the ResMed S8, not the newer S9 which looks at "hypopnea" differently now:

AHI question... - topic started by LaurieJ31981
Aug. 1, 2009
viewtopic.php?p=390817#p390817

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Chart posted by Velbor showing the differing definitions used by the different manufacturers:
April 2, 2009
viewtopic.php?p=356255#p356255

POLL: Typical AHI for ResMed Users - topic started by twokatmew
Aug 29, 2009
viewtopic.php?p=399610#p399610

High HI affecting AHI rating. Should I be worried - topic started by ChrisC
Mar. 30, 2009
viewtopic.php?p=355205

Alternative ways to decrease the AHI - topic started by christo
Dec. 21, 2008
viewtopic.php?p=324087#p324087

I need to stop chasing 0 AHI. - topic started by fortomorrow
Dec. 4, 2008
viewtopic.php?p=319432#p319432

Hubby's AHI sucks... - topic started by Debjax
Feb. 15, 2009
viewtopic.php?p=339278#p339278

[Beachmeezer]

Hi VA Beach,
I'm in VB, too. I had my sleep study and all follow ups at the EVMS Sleep Disorders clinic and thought they were awesome. Did you have your study and follow ups there? - Kim