Normal CPAP scan of person without Apnea/Hypopnea

[jandi]

Hi.
Just wondering what the sleep scan of a person without Apnea/Hypopnea looks like? I gather a normal sleep scan AHI is 5 events. So do you reckon that I would be right in assuming it would look like my scan (which shows AHI 0.7 to 1.4 events), but with 5?
jandi

[jamiswolf]

Jandi,
Rather an obtuse posting. Are you saying you had a sleep study with AHI of .7 to 1.4? And you are wondering if it is normal?

There's no actual statistics for a "normal" sleep study...we're all individuals. But people with treatment for apnea shoot for an AHI of under 5 as a sign of good treatment.

You shouldn't need cpap treatment with those numbers...if that's what you're wondering.
J

[jandi]

jamiswolf

No I started with an AHI of 15 (moderate) 5 yrs ago and constant headaches, migraines, low Sat O2. So CPAP has lowered AHI and I assume raised Sat O2, because headaches and migraines are way less frequent now. Though I do think I hold my breath at times through the night, as I often catch myself doing that during the day.
No, I was just wondering what a normal scan looks like for someone without apean/hypopnea and therefore not on CPAP.

jandi

[SleepingUgly]

I don't really understand your question or your use of the word "scan". On a sleep study, a "normal" person with no OSA would have an AHI < 5. We don't know what they would look like on CPAP; as far as I know, no such study has been done (but I keep trying to recruit "normal" spouses of folks here to do it...). I'd assume their AHI would be <5 on the lowest possible CPAP setting.

[jnk]

Sleep Med Rev. 2002 Feb;6(1):7-14; discussion 15-6.
Montserrat JM, Barbe F, Rodenstein DO.
Hospital Clínic, Universitat de Barcelona, Spain.

. . . A number of studies in general and worker populations have shown that the prevalence of an apnoea-hypopnoea index (AHI) >10 is in the range of 20%. Subjects with an AHI >10 that complain of excessive daytime somnolence, tiredness, asphyxic episodes during the night or non-refreshing sleep, among other symptoms, suffer from the sleep apnoea hypopnoea syndrome (SAHS). The prevalence of SAHS is around 4%. . . . Nasal continuous positive airway pressure (nCPAP) is undoubtedly effective in clearly symptomatic patients. Its use in clinical practice is adequately supported in the treatment of moderate to severe SAHS. Further studies are needed in order to define the lower range of symptoms to be treated. One of the most important problems encountered in this area results from the combination of two situations. On the one hand, different epidemiological studies have demonstrated that an AHI >10 without symptoms is present in around 15% of the general population. On the other hand, several studies suggest that having a high AHI, even without secondary symptoms, gives rise to some undesirable effects such as traffic accidents and cardiovascular consequences. In this context, comprehensive epidemiological studies are therefore warranted to define the role of nCPAP treatment especially in those subjects with a high AHI but with few or no symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/12531138

Also:

The prevalence of OSA in the general population is approximately 20 percent if defined as an apnea hypopnea index (AHI) greater than five events per hour (the AHI is the number of apneas and hypopneas per hour of sleep). In contrast, it is 2 to 9 percent if defined as an AHI greater than five events per hour accompanied by at least one symptom that is known to respond to treatment (eg, daytime sleepiness). Therefore, it is common to be minimally asymptomatic and have an AHI in an abnormal range.

http://www.uptodate.com/contents/overvi ... -in-adults

[VikingGnome]

That's weird. Medicare won't buy a CPAP for somebody with AHI less than 15. If a person has AHI 5-14, Medicare will buy ONLY if the person has conditions such as hypertension, heart disease, neurologic diseases that affect breathing. So a person with AHI of 10 and has excessive Daytime sleepiness will NOT get a CPAP from Medicare. Most insurance companies follow Medicare's rules. So gov't thinks AHI greater than 5 is bad but nobody gets a CPAP until AHI reaches 15.

[idamtnboy]

That's weird. Medicare won't buy a CPAP for somebody with AHI less than 15. If a person has AHI 5-14, Medicare will buy ONLY if the person has conditions such as hypertension, heart disease, neurologic diseases that affect breathing. So a person with AHI of 10 and has excessive Daytime sleepiness will NOT get a CPAP from Medicare. Most insurance companies follow Medicare's rules. So gov't thinks AHI greater than 5 is bad but nobody gets a CPAP until AHI reaches 15.

You're a little bit off. Here's a quote from a Local Coverage Determination document for CPAP. Your example of AHI of 10 and excessive sleepiness does qualify for CPAP.

An E0601 device is covered for the treatment of obstructive sleep apnea (OSA) if criteria A - C are met:
A. The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea.
B. The patient has a sleep test (as defined below) that meets either of the following criteria (1 or 2):
1. The apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater than or equal to 15 events per hour with a minimum of 30
events; or,
2. The AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per hour with a minimum of 10 events and documentation of:
a. Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia; or,
b. Hypertension, ischemic heart disease, or history of stroke.
C. The patient and/or their caregiver has received instruction from the supplier of the device in the proper use and care of the equipment.
If a claim for an E0601 is submitted and all of the criteria above have not been met, it will be denied as not reasonable and necessary.

[jandi]

Thanks for the great info everyone. That is what I meant. So I think my AHI is now even below the average for the population.
I think each country's health system has a different definition of what they will consider significant and what payment they will assist with.

[-tim]

According to that, I don't have sleep apnea in the US... yet I do in Australia? Hmmm

[deltadave]

An E0601 device is covered for the treatment of obstructive sleep apnea (OSA) if criteria A - C are met:
A. The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea.
B. The patient has a sleep test (as defined below) that meets either of the following criteria (1 or 2):
1. The apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater than or equal to 15 events per hour with a minimum of 30
events; or,
2. The AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per hour with a minimum of 10 events and documentation of:
a. Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia; or,
b. Hypertension, ischemic heart disease, or history of stroke.
C. The patient and/or their caregiver has received instruction from the supplier of the device in the proper use and care of the equipment.
If a claim for an E0601 is submitted and all of the criteria above have not been met, it will be denied as not reasonable and necessary.

So if one is an insomniac and is sleepy during the day;

gets a cheap HST and generates 10 events in 2 hours;

the guy rips off the HST cause he can't stand it and just makes him toss and turn;

the 10 events could be (and probably are) post-arousal central apneas (the normal response to tossing and turning);

he can get a paid CPAP machine to treat him for obstructive sleep apnea for the rest of life;

as long as the physcian says "Sure, he's better now than before"?

[jnk]

Well, if the patient really wants to try a CPAP, then the doc should insist on HST, which can't tell if the patient is asleep or awake, and then instruct the patient to spend any awake moments during the night practicing holding his breath. That should make insurance happy, since it should, uh, save everyone a lot of money. On paper anyway. And isn't that what medical tests are mostly for?

And while we're at it, let's let docs take the sleep-doc exam from home over the Internet. That would prove about as much about what the doc knows as an HST proves about how a patient sleeps.

Now we're makin' some REAL progress!

[jamiswolf]

Thanks for the great info everyone. That is what I meant. So I think my AHI is now even below the average for the population.

Yes Jandi...your numbers are great. I hope you feel well too because that's the bottom line.
J

[BlackSpinner]

Except that AHI is not everything. There is also UARS and snoring to consider.