Finished HST, possibly negative?

I agree with those who have supported getting an in-lab study just due to the unanswered questions.

LSAT wrote:There are dozens of members that realize that you are loco.

You shouldn't say that!

(It has to be in the hundreds.)

Hey all, I wanted to post an update to my findings in regards to my results(that I also shared on ApneaBoard). I was up till two last night researching. Lol.

So, I've been staring at my results that's posted on the third post of this thread when I noticed something odd.

I was peering at (link I can't post here. It was a PDF manual for the ApneaLink and related software. It won't be hard to find via a Google search) which details the inner workings of the device used for the HST and how the specific software works. It even details what the acronyms are and how they're calculated. I looked through this PDF to learn what FL and FS's were(for those too lazy to look, they're Flow Limitations without snores(FL) and Flow Limitations with snores(FS)) and realized that I had a recorded 8900 breathes throughout the night with MORE THAN HALF of those being limited without snoring(FL = 5883). On the left under Indices, that shows up as 66% of my total breathes while sleeping to be limited in flow. This specific study group states that 60% is considered normal, while 40% of FS is considered normal. I've seen normals usually be considered 10% lower than what's specified here, not to mention that the amount of times this FL occurs, it could most definitely account for the low oxy sat we're seeing here.

This brings me to the desat levels. As pointed out by another user, the levels are insane at the nadir, but it's the AMOUNT of desats that worry me. The ApneaLink Air qualifies a desat as a 4% drop in oxygen level meaning that over the course of the night, I experience rapid drops of oxygen saturation multiple times, 65 if we're keeping count. This in itself, while high isn't as extreme as seen in patients afflicted with OSA or CA(I've seen reports so far as high as almost 300 desat events). However, this doesn't count anything below 4%, meaning along with all the times I experienced an FL, I dropped anywhere from 1-3% in my sat levels.... 6000 times during my sleep. f*** me man. I never once went above 97%(which may not be true for daytime measurements as the evaluation started maybe ten minutes after the recording started)during my sleep with an average of 91% throughout the night. It should be noted that most places that do studies say 3% or more is a desat event. The default for the Air is 4%, but can be modified by the study. This is important because not only does this mean it's less sensitive, it also means that a lot more breathes did not make it into this count. This test seems to be designed to only detect moderate to severe cases of OSA in people, otherwise numbers would probably be off the charts.

Without EEG or ECG recording to detect sleep state or muscle movement, of course the FLs I experienced wouldn't show up as Hypopneas, as they shouldn't. They would show up as RERAs. The kicker is that 30 of the FLs I experienced DID register and show up in the test. Everything here points to increased resistance for whatever reason, whether that be weight, neck size or because I have sh**ty nostrils. Adding that to the spikes of heart rate and you have some good ol' lookin' UARS(without accounting for other physiological problems). The only thing I DON'T have is the stress stats and breath waveforms, which should hopefully pop up sometime tomorrow. What I'm predicting is that my stress stat shouldn't be out of whack, especially considering the sleep group didn't mention it. I DO expect shallow breathing, odd patterns of stress that matches with the BPM and saturation, possibly indicating arousals at peak points. What would truly help would be a breathing waveform. Hopefully the data includes this as well.


Another important piece of information that I didn't realize was brought up by SleepRider on ApneaBoard:

One thing to keep in mind with chronic flow limitation is that it hides hypopnea by reducing baseline respiratory flow and volume. As a result the 50% flow reduction generally required to score hypopnea is actually much closer to an apnea. In other words, flow is already impaired to hypopnea levels all the time. We can usually see this in reading a flow rate chart. A better definition of hypopnea is:

"Hypopnea is defined as reduction in ventilation of at least 50% and/or a decrease in arterial saturation of 4% or more due to partial airway obstruction"

Under this definition you score nearly continuous hypopnea through the night.

Perfect.

tl;dr: I think my HST, however limited in information, may indicate that I have UARS based on the FL count, low but present amount of hypopneas, false baslines caused by chronic FL counts, oxy sat and BPM.

What do you think? And If I'm wrong about anything in here, please correct me. I don't want to talk out of my ass, as I'm only using what I've learned here and the internet.

My first thought yesterday was "prime candidate for UARS diagnosis".
With the results posted and symptoms and low AHI... UARS definitely moves to the top of the list of suspects and needs to be ruled in or out.

So for what is is worth...I agree with you and don't think you are talking out your ass.

Pugsy wrote:My first thought yesterday was "prime candidate for UARS diagnosis".
With the results posted and symptoms and low AHI... UARS definitely moves to the top of the list of suspects and needs to be ruled in or out.

So for what is is worth...I agree with you and don't think you are talking out your ass.

WHOOO! I'm glad this matches up with someone! I'm hoping that another UARS forum member will be able to stop by and give me some details on what their results looked like, how an xPAP worked for them, and how long the improvement took. To be honest, it's difficult to find ApneaLink HST results on line. It's like people don't want their medical documents floating around on the internet!

That being said, are there any other conditions that could possibly give these type of results?

PS: Wow. Sleep Study won't give me my raw data. I was really hoping it wouldn't go this route. Before I start throwing words and accusations, threats and letters, I'm going to do some more research on this and HIPAA.

Does anyone know why they would do this, and if they CAN legally do this? I was under the impression that HIPAA laws (if I remember correctly from my medical assisting days) basically state that a person has the right to all medical data, raw and not, even if the request is unusual.

xxyzx wrote: please post a link to that pdf
thanks

I can't post links. Being a guest account and all.

I don't have UARS. I have plain vanilla OSA but we do have a few forum members with UARS. Not many but a few using cpap.
It's not a quick fix...wish I could tell you differently but the truth is that the usual markers we use to optimize therapy with cpaps aren't much help with UARS. The data the machines offer us is geared to OSA and not UARS.
UARS patients have to rely on subjective feelings more and not good numbers on the reports the full data cpap machines record. UARS patients already have low AHI numbers. It's hard because people want to use some sort of number to gauge therapy and with UARS we can't go by the numbers. Have to go by how they feel and results aren't usually quick and take some time and experimenting to get to where they are sleeping better.

Insurance covering cpap is another problem. Most want people to have an OSA diagnosis before they will pay for cpap.

You may or may not have UARS...but it is possible...and that's why I said what I said earlier...gotta look at other potential causes for your symptoms too. Rule them out or in type of thing. I have no idea what other conditions would give these type of results. Sorry. I just know that a good complete work up is needed to rule out other potential culprits for the various symptoms. Some of the obvious ones...fatigue and thyroid issues...

I know we like to have something with a name so that we have something we can fight.
Lots of things mess with sleep quality besides sleep apnea or UARS. I have my own issues with other health problems that mess with my sleep....unrelated to sleep apnea and the best cpap therapy in the world can't fix those issues. I have to tackle those separately.

xxyzx wrote: UARS is a definite possibility
RERAs are quite likely disturbing your sleep

the question is can xpap fix your UARs ?
can something else help the RERAs and UAR better ?

loss of air flow from UAR is less than FL is less than hypop is less than apnea

There are a few options for treating UARS. Dental appliances are one. This is usually not as effective as going the xPAP route, but is sometimes the first route people go when attempting to treat UARS since it's not full blown apnea. You have to keep in mind that UARS causes FL. UARS isn't a symptom in itself, it's a condition caused by whatever problem you have. While you can argue that the fact it's caused by another problem makes it a symptom, that's not how UARS is typically handled in a medical setting from what I've been reading.

So taking that into considering, UARS and Apnea are typically seen on the same spectrum, with UARS being at the start and OSA on the other end, making it part of a progressive disease. Of course, not everyone who suffers from UARS ends up diagnosed with OSA. That's a given.

But I digress, RERAs are caused by FLs(along with apneas, but less so), which is in turn caused by UARS(or hypopneas) in this case. Treat the UARS(xPAPs, surgeries, dental accessories), you treat the FLs, which treat the RERAs. So yes, typically the solution to UARS is to treat it like OSA. Provided this doesn't push it into CA territory, the added pressure is usually enough to solve the problem.

xxyzx wrote: you can give us the google words you searched with
or you could post the pieces of the link using spaces or spell out at or dotcom and we can figure out the link to use

Google "ApneaLink Air Clinical Guide", look for "ApneaLinkAir ApneaLink Plus - AirView - ResMed". It'll be a PDF file.

Pugsy wrote:I don't have UARS. I have plain vanilla OSA but we do have a few forum members with UARS. Not many but a few using cpap.
It's not a quick fix...wish I could tell you differently but the truth is that the usual markers we use to optimize therapy with cpaps aren't much help with UARS. The data the machines offer us is geared to OSA and not UARS.
UARS patients have to rely on subjective feelings more and not good numbers on the reports the full data cpap machines record. UARS patients already have low AHI numbers. It's hard because people want to use some sort of number to gauge therapy and with UARS we can't go by the numbers. Have to go by how they feel and results aren't usually quick and take some time and experimenting to get to where they are sleeping better.

Insurance covering cpap is another problem. Most want people to have an OSA diagnosis before they will pay for cpap.

You may or may not have UARS...but it is possible...and that's why I said what I said earlier...gotta look at other potential causes for your symptoms too. Rule them out or in type of thing. I have no idea what other conditions would give these type of results. Sorry. I just know that a good complete work up is needed to rule out other potential culprits for the various symptoms. Some of the obvious ones...fatigue and thyroid issues...

I know we like to have something with a name so that we have something we can fight.
Lots of things mess with sleep quality besides sleep apnea or UARS. I have my own issues with other health problems that mess with my sleep....unrelated to sleep apnea and the best cpap therapy in the world can't fix those issues. I have to tackle those separately.

I can tell you for one that it probably isn't any type of thyroid problem. I've had a blood test done and it came back find on all accounts with the exception of slightly elevated liver enzymes that may be attributed to fatty liver(won't know for sure until I get a ultrasound), which I find absolutely hilarious considering that fatty liver can be a side effect of low oxygen saturation.

I wouldn't think CPAPs would fix UARS, at least from what I've learned, it would more than likely just cause more issues. With UARS, If we apply say just a straight CPAP with a high enough pressure, it'll kill the the symptoms, but then you've got constant pressure surging down on the poor bastard who has to deal with it. It would probably just cause CAs. or at the very least, cause sleeping interruptions/arousal, and EPIs, which is basically UARS all over again.

This or that, my sleeping habits haven't changed anytime during the years with the exception of doing night shifts which only lasted 8 months, and that was during the time I was experiencing these issues.

UPDATE: I just wanted to inform people that I received my OSA file from the sleep study after speaking with the Director of the program, and managed to find a way to view the files.


The results are.... Interesting.. To say the least. I'm not completely sure what I'm viewing but comparing results online and reading documents is indeed providing a lot of insight to my issues. There are multiple cases of insane flow deviation with no events associated to them, multiple times where the pulse and saturation dip and increase off the charts (may be invalid readings due to movement or the such). I'm gonna be up all night looking through it.


While I'm not exactly sure how to, I know there's way to obfuscate personal data in the records. I'm going to play around with this and see, but once I do, I don't mind providing it for further insight, unless someone has a better way/idea to share the results.

Ruekl wrote: I know there's way to obfuscate personal data in the records.

Create an image(s) of the records and use an app like paint.net or similar to snip out or blur personal data and doctor/facility.

Upload the image(s) to imgur.com (https://sleep.tnet.com/reference/tips/imgur). Post the links to the images here.

Since you are still a guest, you cannot post links. So modify the link like this and we will know how to access it -->

Original URL: https://i.imgur.com/oeWfI3h.jpg

Modified URL: i dot imgur dot com slash oeWfI3h.jpg

ChicagoGranny wrote:

Ruekl wrote: I know there's way to obfuscate personal data in the records.

Create an image(s) of the records and use an app like paint or similar to snip out or blur personal data and doctor/facility.

Upload the image(s) to imgur. Post the links to the images here.

Hahahhaha, that xxxxxx picture. That's amazing. I've linked my record below. I also have acess to the raw data file and I've removed all personal data from it. If you'd like that instead, let me know and I'll supply it.

link removed by moderator

Rukel wrote:Hahahhaha, that xxxxxx picture. That's amazing.

Every time I see his photo, I want to bake him a 1770 House Meatloaf and pour him a big glass of Baby Blue.