Strange Test Results?

[Geer1]

Hi,

I have been fighting some health issues (wide range of symptoms, fatigue being on of the main ones) for a while now and I was finally given my first diagnosis, sleep apnea.

I was looking over the results and it seems that there is definitely something wrong but based on the little knowledge I have this does not seem to be typical sleep apnea. I am going to do some research but figured I would post on here to get others thoughts as I assume some of you are much more knowledgeable/experienced then I am.

As you can see in the attached images I have very few apneas, a number of hypopneas and significant oxygen desaturation early in the morning but from what I see this does not seem to correlate with apnea or hypopnea events. My heart rate increases dramatically during this time, the sleep therapist couldn't remember ever seeing a heart rate this high (226 bpm).

I will be doing a 2nd test but just curious if anyone with more knowledge/experience with this stuff would be willing to comment as to whether this seems to be sleep apnea related or oxygen desaturation due to some other issue/sleep disorder. I believe the data is being looked at again and as mentioned I am also doing a 2nd test.

Sleep Apnea 1.jpg (189.55 KiB) Viewed 816 times

Sleep Apnea 2.jpg (148.67 KiB) Viewed 816 times

[kteague]

Hello and welcome. While we wait for those more knowledgeable about interpreting test results, I'd just like to ask if you have seen a doctor to evaluate that heart rate? If it were me and there was no reason to suspect an equipment malfunction, I'd want a cardiac evaluation to be priority and immediate. Have you already done a Holter Monitor study? If so, what did it show?

[Geer1]

Hello and welcome. While we wait for those more knowledgeable about interpreting test results, I'd just like to ask if you have seen a doctor to evaluate that heart rate? If it were me and there was no reason to suspect an equipment malfunction, I'd want a cardiac evaluation to be priority and immediate. Have you already done a Holter Monitor study? If so, what did it show?

I just got these details yesterday so trying to figure everything out. A friend who is a doctor mentioned Holter test too.

In my brief googling yesterday this chart seems more in line with a neuromuscular disorder, COPD (don't think I have COPD) or something else I haven't researched yet. Those both can cause fairly normal oxygen levels that crash during rem sleep. I can't be 100% sure those times were rem sleep but I believe they were based on sleep pattern and it would also explain why I almost never dream or at least remember dreaming.

The sleep therapist I saw didn't think I need an in clinic sleep study but I think that is exactly what I need based on my findings so far and like you say probably a holter test too.

[Okie bipap]

Many of your symptoms are typical of sleep apnea. It is common for people to have more events during REM and need more pressure during REM sleep than during non-REM sleep. After an apnea, the brain wakes you up, raises the heart rate, causes deep breaths, etc. in order to raise the blood oxygen level. You typically do not remember these brief wake up periods, but they do cause us to have many of the symptoms you have. If you can prevent the events from happening, your heart rate will probably settle down and not have the high rates you are having.

[palerider]

Those o2 changes and pulse changes look like measurement artifacts, they look too abrupt to be real, but that might be an effect of the scrunched up scale of the graph.

[Geer1]

Many of your symptoms are typical of sleep apnea. It is common for people to have more events during REM and need more pressure during REM sleep than during non-REM sleep. After an apnea, the brain wakes you up, raises the heart rate, causes deep breaths, etc. in order to raise the blood oxygen level. You typically do not remember these brief wake up periods, but they do cause us to have many of the symptoms you have. If you can prevent the events from happening, your heart rate will probably settle down and not have the high rates you are having.

According to the results there were almost no apnea or hypopnea events during the main time of oxygen desaturation, that may be due to comment below though.

Those o2 changes and pulse changes look like measurement artifacts, they look too abrupt to be real, but that might be an effect of the scrunched up scale of the graph.

I was wondering about that with the oxygen saturation specifically(spiking to/above 100%). Like you say the graph is very compressed so that could be causing it.

One other thing I noticed is "Hypopneas were scored only if there was valid oximetry data". So perhaps hypopneas are causing the oxygen desaturation and just aren't shown because either the oximeter wasn't working properly during that period or the values were considered out of range or something along those lines.

I assume this is all part of the reason that they are sending my test data out to be manually interpreted and having me do a 2nd test as well.

[kteague]

Maybe I'm a bit jaded, but doing the same test again doesn't seem the path I would have confidence in yet. Then what's the next step, do a 3rd to see which of the first two to believe? Please do let us know what the review of the study turns up. Maybe that will give some clarity on next steps.

[Geer1]

Maybe I'm a bit jaded, but doing the same test again doesn't seem the path I would have confidence in yet. Then what's the next step, do a 3rd to see which of the first two to believe? Please do let us know what the review of the study turns up. Maybe that will give some clarity on next steps.

One of the reasons for the 2nd test is to see if my AHI will be high enough to qualify for insurance coverage. They won't cover 9.5 AHI and they don't take oxygen saturation into account...

Many members of my family have OSA. Most have far worse AHI but I have one of the lowest oxygen levels (grandfather at 45 AHI and 64% oxygen is the only one worse).

[chunkyfrog]

Go for the Holter monitor/referral to a cardiologist.
Once that is addressed, then you go after the apnea.

[Geer1]

Dr gave me my updated results after manual review. Makes more sense now, they added a bunch more hypopneas and desaturation events in the morning hours when oxygen levels were dropping. AHI increased to 16.3, ODI increased to 13.3. Total of 3 obstructive apneas, 5 central apneas and 135 hypopneas.

This time I was given a sheet with some extra notes. There was a note of periods of poor oximetry signal which I am assuming was when the hypopneas weren't originally scored. SPO2 and pulse numbers were unchanged.

Updated chart on top, old chart on bottom.

[Geer1]

Holter test complete. Results were "normal". Cardiologist believes the sleep study reported values were incorrect and likely artifacts.

Been on CPAP just over 2 weeks now. Started at 4-16 but changed it to 8-16 which I find more comfortable. AHI has varied between 0.15 to 1.34 with min pressure of 8 and max usually reaching around 10. Feeling a bit better even though still not sleeping great (averaging under 7 hrs of sleep and interrupted). I tried autoset for her setting for two nights but had two of my worst nights (1.12 and 1.83 AHI and higher flow limitation which I found interesting as I thought it was supposed to be more responsive to flow limitation).

I have been using a P10 mask and find that the hose is annoying, best way I have found is to route it up behind my head/pillow. When trying to sleep on my side I find the mask gets pushed to the side causing a leak which then wakes me up. I am going to try a P30i/N30i and see if that helps with both comfort of having the hose behind head and hopefully able to sleep on side with fewer leaks.

[Pugsy]

The for Her mode historically visually looks worse in terms of the FL graph than the regular mode looks.
You are trying to compare apples and oranges in this situation. Not quite a fair comparison.

[palerider]

which I found interesting as I thought it was supposed to be more responsive to flow limitation).

And why did you thought that?

Not listed in the manual...

[Miss Emerita]

If you want to keep trying with the P10, you might have fewer problems if you used a firmer pillow under your head. A hose lift (stand) might also be worth a thought.

[Geer1]

And why did you thought that?

Not listed in the manual...

https://www.resmed.com/us/en/healthcare ... r-her.html

The pioneering new algorithm used in the AirSense 10 AutoSet for Her works by increasing sensitivity to flow limitation and optimizing the response to these events. By responding to each flow-limited breath, the algorithm helps provide comfortable therapy for women.

I'm not sold it was the setting change, it could have just been a bad night. My pressure variation is minimal so I doubt it makes that much of a difference which setting I use.