Cutoff AHI for treatment

[george45]

I haven't had much luck geting feedback in my posts so I'll keep this one simple. What is the cutoff AHI for advising treatment. I've seen 10, 15 and 20. Does anyone know for sure?

[wading thru the muck!]

15 or more unless you have other related conditions such as high BP or excessive daytime sleepiness or diabetes etc...

[ozij]

Do you mean medical, or do you mean insurance?
O.

[rested gal]

Good question, ozij.

Colin Sullivan, the inventor of the cpap machine has his own take on what AHI warrants treatment...he thinks AHI is not as important as clinical symptoms and how a person responds to cpap even if their AHI is "low". (I agree.)

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

Of course when you're trying to get treatment paid for, Medicare/insurance have their own ideas.

[TXKajun]

What an incredibly timely thread!

I have been lowering my pressures on my 420e based on my AHI for the last few weeks (I have been trying to get it down to the lowest possible level for comfort reasons). I finally got down to a low pressure of 7 cm and a high pressure of 11 cm for the last 3 nights. The results, AHI-wise are great. My AHI with my UltraMirage FF mask have been around 3 to 4, with the DreamFit the AHI has been under 1. Unfortunately, I have felt almost pre-CPAP the last 3 days!! Sleepy at work, no energy, etc.

This morning, I bumped up pressures to 9 and 14. Hopefully this will get me back to where I need to be treatment-wise and restore my energy.

This therapy WORKS!!! but only if you do it right!!!

[BP]

This begs the question. If the algorithm via the software, is telling us that we are having very few events, and you still feel bad, then what good is the software?

(BTW, can you tell me which screen in SL3.6 that it gives an AHI? I have found AI, HI, and various other indexes, but not AHI.)

I guess what I'm trying to say is, if you, for instance have an AHI of 1 at a pressure of 7cm, and feel bad, and also have an AHI of 1 at a pressure of 9cm and feel good, then in my opion the software is useless. Am I missing something?

I know the therapy WORKS!! But, how do you define, "doing it right". In the software world, we call it V&V, Verification and Validation. It's not enough to be building the product right, if you aren't building the right product.

Interesting thread.

-BP

[wading thru the muck!]

BP,


With the Silverlining software you have to add the AI and HI together to get your AHI.

If you are getting good numbers and you still feel crummy, then it would point you to some other sleep disturbance such as RLS (restless leg syndrom) etc...

Many things can be causing you to get a lousy nights sleep.

[HisServ]

I just want to add this. Even if you have a low AHI like 8 or 10 or something below the cutoff and high oxygen numbers like 95% or anything above 90, you could STILL be feeling the effects of not sleeping well. If this is the case with you, you might want to consider atleast trying a CPAP. It very well may help with tiredness, moodiness, and other symptoms of poor quality of sleep. If you feel that it may help, please pursue this and don't let doctors tell you otherwise just becuase your number isn't quite high enough. That's my 2c anyway.

[BP]

Sorry guys, I was, more or less, directly addressing TXKajun's comments. I am already on CPAP therapy, and I have been using silver lining 3.6 for a couple of nights now. TXKajun's post got me thinking about the accuracy of the software that comes with the different auto-paps. I mean, if the indexes are the same at two different pressures, but you feel good at one pressure, and bad at the other pressure, then the software has told you nothing. You might as well just go by how you feel. Does anyone disagree with me? Again, I'm not talking about whether you have some other condition, such as plmd, etc. I am specifically talking about this comment in particular made by TXKajun:

I finally got down to a low pressure of 7 cm and a high pressure of 11 cm for the last 3 nights. The results, AHI-wise are great. My AHI with my UltraMirage FF mask have been around 3 to 4, with the DreamFit the AHI has been under 1. Unfortunately, I have felt almost pre-CPAP the last 3 days!! Sleepy at work, no energy, etc.

This morning, I bumped up pressures to 9 and 14. Hopefully this will get me back to where I need to be treatment-wise and restore my energy.

With an AHI of under 1, TXKajun is not going to be able to lower that significantly by going to a higher pressure. He or she, sorry, could only hope to match it. So my point is, the software reports, are not giving him any indication of treatment success. So why use it? I'm not putting down the software or anything, I'm just trying to understand whether I should be relying on the software as any indication of good treatment. I've done a great deal of research on this site and others, and generally that's what people try to do. They try to get their ahi as low as possible.

Hopefully I have explained my thoughts. Anybody else want to weigh in on this issue?

-BP

[SnoreNoMore2005]

My sleep doc told me that a healthy person without OSA will have an AHI of 5 or less. It would take an AHI of 15 or more to warrant CPAP. Of course, there are many other factors to consider besides AHI.

SnoreNoMore2005

[snork1]

I have heard that the clinical cutoff point is considered to be 5 AHI.

I tend to agree that the Silver Lining software pretty much sucks. I realize I might be biased by living in Microsoft land, but I am not sure that european software designers have kept up with the world for creating user friendly software.

I think pinning it on JUST AHI is like asking "Whats your sign?", lumping too many people under one number.

You really need to look at which of the numbers are most affecting oxygen saturation, and other variables like Restless Leg syndrome. The software....if you can figure it out....is just a starting point.

You also have to look at the software readouts to see how the events are clustered and how they sit relative to leaks and look for any other trends that seem to match up with how you feel on the AVERAGE.

Too bad we don't have trained professionals that actually care enough to ANALYZE all this stuff for us. I certainly have not heard of a sleep doc yet that is willing to get into it that deep, which leaves us to figure it out as best we can with whatever tools we have.

I sure do like my 420E, but the software gives me a greater appreciation for the Encore Pro software, which didn't particularly impress me to begin with!

[rested gal]

. What is the cutoff AHI for advising treatment. I've seen 10, 15 and 20. Does anyone know for sure?

A very knowledgable RPSGT, RRT wrote this in a reply to a post on another message board: Sep 21, 2005 subject: sleep study
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The guidelines for qualifying sleep apnea as mild, moderate or severe really rest on 3 criteria: AHI, lowest desaturation and severity of EDS. There is some variation in where the cutoffs are, but probably the best reference right now is from 1999 Sleep:

The severity of sleep apnea can be categorized as mild, moderate, or severe on the basis of the apnea-hypopnea index. Mild sleep apnea is defined by an apnea-hypopnea index from 5 to 14, an oxygen saturation of at least 86%, and minimal daytime disability.

Moderate sleep apnea is defined by an index from 15 to 30 or an oxygen saturation of 80% to 85% and significant work or social dysfunction due to drowsiness and loss of concentration.

Severe sleep apnea is defined by an index greater than 30 or an oxygen saturation of 79% or less and incapacitation due to the sleep disorder.

Flemons WW. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22(5):667-89.

You really have to consider all three factors. If your AHI is 28 but you desat to 60%, then severe may be a better description. Similarly, if your AHI is 35 but you have no desats below 90%, then perhaps moderate would be a better description.

Although I think a wider moderate AHI range would better reflect these 3 factors, just to make sure that everybody's on the same page we'll use these AHI ranges to classify OSA in the mild, moderate and severe caregories.

sleepydave
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sleepydave also posts great info on this message board, under the nickname deltadave. He knows his stuff.

[deltadave]

Aw shucks, I ain't nothin'.

And it goes without saying, if you had an AHI of 12 but got your sleep study as a result of having an auto accident because you fell asleep at the wheel, I wouldn't try to convince you that the OSA was mild.

And you know the Medicare rules that say you can have CPAP if your AHI is 5-14 but have EDS?
Well, when you score hypopneas in Medicare, you can only use desaturations, not arousals, the thing that CAUSES THE EDS IN THE FIRST PLACE!!! ARRRRRGGGHHHH!

Medicare Guidelines

RG's article from Colin Sullivan is most pertinent, and again, underscores that you should think beyond "mild, moderate, severe" and even "AHI" in determining what's right for you.

delta, sleepy, whoever, dave

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CPAPopedia Keywords Contained In This Post (Click For Definition): medicare, CPAP, AHI, auto

[TXKajun]

Good morning, everyone, especially BP! And I DO mean "good" morning!

In relation to what I posted above, last night's results were pretty much the same AHI-wise, but I'm feeling super this morning. Energy level back up, feeling rested and, in general, back to where I hoped to be. And that was the result of bumping my pressures up to 9 and 14 last night on my 420E.

BP, IMHO (and this is only my opinion and I am in no way a doctor, RT or otherwise a medical professional), there must be more elements involved in APAP/CPAP/BiPAP than just looking at an AHI or oxygen desaturation level. I don't have restless leg syndrome or any of the other "add-on" problems that would cause bad sleep. Several folks here on the board have recommended bumping up pressures if the therapy doesn't seem to be working and the folks who have tried it seem to have had, overall, good success with that. Last night, for me at least, confirmed that. I don't really have a good reason as to why, seeing as how my AHI hasn't significantly changed between 7-11 cm and 9-14 cm (btw, the highest my pressure got last night was 12 cm). I sleep good at the lower setting, don't wake much and it's a bit more comfortable to breathe, but I felt like pre-APAP. This morning, like I said, I feel great. It would be nice to have had an oxygen sensor to check on desaturations the last 5 nights or so, but given how I feel today compared to the last 3 nights, I'm not going to go back to a lower pressure. I've found what works for me and I'm sticking with it!

Anyone have any theories??? Again, this was a timely thread for me. Thanks!

This therapy WORKS!!! (but only if you do it right!!)

[deltadave]

BTW, if you're interested in the Sleepiness Guidelines from the 1999 paper to try to get a handle on "how sleepy is sleepy", they are:

Mild: Unwanted sleepiness or involuntary sleep episodes occur during activities that require little attention. Examples include sleepiness that is likely to occur while watching television, reading, or traveling as a passenger. Symptoms produce only minor impairment of social or occupational function.
Moderate: Unwanted sleepiness or involuntary sleep episodes occur during activities that require some attention. Examples include uncontrollable sleepiness that is likely to occur while attending activities such as concerts, meetings or presentations. Symptoms produce moderate impairment of social or occupational function.
Severe: Unwanted sleepiness or involuntary sleep episodes occur during activities that require more active attention. Examples include uncontrollable sleepiness while eating, during conversation, walking, or driving. Symptoms produce marked impairment in social or occupational function.
Flemons WW. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22(5):667-89.

deltadave