Do I or don't I (have sleep apnea)?

sydknits · Post by **sydknits** » Thu Aug 30, 2007 7:43 am

I'm really confused. I had my 3rd sleep study last night. For the most part, the primary results were different for each one. I won't get into the details of the numbers for now, but here are the highlights:

1st study (4/06): No sleep apnea, Restless Leg Syndrome
2nd study (7/06): Severe sleep apnea (AHI=54.1), no RLS
3rd study (8/07): No sleep apnea, no RLS

Different doctors and technicians reading the results each time.

There are a few things that were consistent:
* oxygenation is fine - lowest was 93%
* No Stage 3/4 sleep and virtually no REM sleep

The dr who reviewed the most recent study is now suggesting that I don't have SA at all, since 2 of 3 studies did not show any events), because of my size (5'1'' - 120 lbs) and because I don't snore. She couldn't explain why the 2nd study showed severe apnea and my APAP machine shows AHI's of anywhere from 3 to 8 every night. Sometimes I'll have nights with 0 events, but I thought that was a software glitch because sometimes there will be a week or so worth of data totally missing from the MyEncore Pro reports.

Now I'm scheduled for a 4th sleep study followed by a MSLT in 2 weeks to test for narcolepsy. After that, my new psychiatrist (who is also the director of the sleep lab) should be back and hopefully he can shed some light on this.

But my questions now for the group are:
1. Has anyone else has had conflicting results on their sleep studies with respect to whether or not they have sleep apnea?
2. Does it make sense that 2 out of 3 sleep studies could have found none? (In the first study I slept on my side - I was told that may have been the reason. In the 2nd and 3rd I slept on my back and still got conflicting results).
3. My major symptom is chronic and often severe insomnia. If it's not OSA or RLS that's causing it, I'm taking an anti-depressant that's resolved all the other symptoms, and they don't think it's narcolepsy either, what else might be causing the fractured sleep architecture?
4. Are there any specific questions that I should ask my doctor that I may not be aware of?

Any thoughts would be greatly appreciated. Thanks!

NeedinZs · Post by **NeedinZs** » Thu Aug 30, 2007 8:40 am

Wow, Syd, you must be totally frustrated and bewildered!
I'm relatively new to all this, I am sorry I can't really answer your questions.

Are you on CPAP everynight? Does it help when you are?
There are a lot of smart cookies on here, I've found, so hang in there,
I'm sure someone will have some suggestions soon!

I noticed you said you didn't snore and showed some Central apneas?
My mom has those as well, and I've noticed watching her sleep (in naps, usually) that it is nothing like the obstructive kind, no snoring whatsoever, she just totally stops breathing, with no signs of it coming.

Maybe on one of the nights of the sleep study, you just didn't happen to have any Central Apnea, THAT NIGHT. Doesn't make since that they could say you don't have it, when it obviously has shown up in another test.
Also, if you really didn't get into a deep enough sleep, they couldn't have occured??

Best of luck, hope you get some answers or suggestions soon!

ozij · Post by **ozij** » Thu Aug 30, 2007 11:12 am

Chest. 2000;118:353-359.)
© 2000 American College of Chest Physicians

http://www.chestjournal.org/cgi/content ... /118/2/353

Mild to Moderate Sleep Respiratory Events*
One Negative Night May Not Be Enough
Olivier Le Bon, MD; Guy Hoffmann, PhD; Juan Tecco, MD; Luc Staner, MD; André Noseda, MD, PhD; Isidore Pelc, MD, PhD and Paul Linkowski, MD, PhD
* From the Centre Hospitalier Universitaire Brugmann (Drs. Le Bon, Hoffmann, Tecco, Noseda, and Pelc), Université Libre de Bruxelles, Brussels, Belgium; Sleep Laboratory (Dr. Staner), FORENAP, Centre Hospitalier Rouffach, France; Hôpital Universitaire Erasme (Dr. Linkowski), Université Libre de Bruxelles, Brussels, Belgium.

Correspondence to: Olivier Le Bon, MD, CHU Brugmann, Service de Psychiatrie, S48, Place Van Gehuchten 4, 1020 Bruxelles, Belgium; e-mail: lebono@ulb.ac.be

Study objectives: Reports on the reproducibility of apnea-hypopnea indexes (AHIs) across sequential polysomnography (PSG) sessions are conflicting, leading to a lack of clear recommendations on the optimal use of this technique: is one night of monitoring sufficient or is a second night required in order to safely reject the diagnosis?

Design: Retrospective comparison of two consecutive nights.

Setting: Sleep unit of a tertiary-care facility.

Patients: Two hundred forty-three subjects with suspected sleep apneas.

Interventions: Two sequential PSG sessions in a sleep unit.

Measurements and results: Using analysis of covariance for repeated measures, with age and body mass index as covariates and gender as a cofactor, a classic first-night effect was found for sleep variables. In addition, a night effect was demonstrated for sleep respiratory variables. Moreover, the high variability of AHIs showed that many patients had their condition diagnosed on only one of the two nights, and more often on the second night than on the first. The gain in detection by adding a second night when the results of testing on the first were negative was between 15% and 25%, according to the AHI obtained on night 1.

Conclusions: Considering the disability associated with sleep apnea/hypopnea syndrome, as well as its global cost for society, the present study shows that it is worth performing two consecutive PSG sessions or at least a second one when the result of the first one is negative in all patients admitted for apnea detection.

Key Words: apnea-hypopnea index • first-night effect • polysomnography • sleep • sleep apnea syndrome

My PSG night gave me an RDI of a bit more than 4. I insisted on titration, slept pretty bad that night, and apparently, with cpap, had a RDI of 18. Was given a APAP for a 2 week home trial, and have been using apap for 2.5 years since - and feeling much much better.

Whenever my AHI is getting close to 3, I know it before looking at the data, because I just don't feel good enough.

I don't know what caused the difference in you studies, but losing so much data on Encore pro makes no sense to me at all - I would distrust the machine. And if your machine is not reliable, and your subconcious mind knows it, that may explain the fact that this therapy has done nothing for you insomnia.

StillAnotherGuest might shed more light on your fractured sleep architecture, I hope he picks this up.

O.

kteague · Post by **kteague** » Thu Aug 30, 2007 11:57 am

Hi. Just lost my post by trying to edit the preview, but in a nutshell, test variations are not unusual, especially if multiple sleep disorders are involved. How deeply you slept, position, if REM was attained, are all variables that could affect whether respiratory events or movements caused arousals.

Just from dealing with this for many years, my perspective is if you were fortunate enough that your OSA was picked up at any time, be glad and continue treatment. It is possible that when respiratory events are not showing up that arousals from movements happened too frequently for obstructions to happen. Those negative reports can give one a false sense of security, when they may not be indicative of your every night status.

Hope you find answers and solutions soon.

Kathy

jskinner · Post by **jskinner** » Thu Aug 30, 2007 2:57 pm

sydknits wrote: * No Stage 3/4 sleep and virtually no REM sleep

I have had 3 sleep studies in the past 2 years. In all expect one I had no 2/3 stage or REM sleep. The first sleep Dr. claimed that this meant I didn't have a sleep disorder but that I had psychiatric problems since I couldn't fall asleep! When the second lab tested me they found moderate sleep apnea but ordered a retest because I never got past stage 2. (What a good lab should do IMHO) During the retest I made it into REM once and showed severe sleep apnea.

My current ENT believes that I have OSA but thinks there is more going than just OSA since I often don't make it past stage 2 in studies. (I'm not convinced, I think a light sleeper might just never be able to get past stage two if they have OSA)

sydknits wrote: The dr who reviewed the most recent study is now suggesting that I don't have SA at all, since 2 of 3 studies did not show any events), because of my size (5'1'' - 120 lbs) and because I don't snore.

I am not overweight and don't snore yet I have OSA. I don't think those are good reasons (Although I have ran into doctors that think that way also)

sydknits wrote:She couldn't explain why the 2nd study showed severe apnea and my APAP machine shows AHI's of anywhere from 3 to 8 every night.

I doubt if the machine is lying

sydknits wrote: 1. Has anyone else has had conflicting results on their sleep studies with respect to whether or not they have sleep apnea?

Yep:
Study #1: RDI 11 // Doctor claims no OSA, I suffer for 6 more months
Study #2: AHI 22 // Retest ordered due to poor sleep
Study #3: AHI 55

For me I believe it had to do with how deeply I managed to get to sleep. When I finally got a good sleep in the lab they could see the problem.

SleepyNoMore · Post by **SleepyNoMore** » Thu Aug 30, 2007 10:21 pm

I am 5 ft. 2inches tall and weight 124 pounds and I have SEVERE Sleep Apnea, relay that back to your "DOCTOR", I know that alot of extra weight makes the apnea worse but my gosh, for a DOCTOR to think that short thin people can't have apnea is @#@#! beyond me. I have snored all my life even when I only weighed 99 lbs. and wore a size 3! I WANT TO ASK ALL "DOCTORS", what the heck does weight have to do with APNEA/STOP BREATHING !!!!!!!!!!!! Unbelievable, I wish you all the luck with this and OH, instead of going to the sleep lab to have your study ask them to do a home study and they will come out to your house and hook you up and instead of wearing 22 wires, you'll only have to wear 5 or 6. That's what they did for me and the test came out perfect, just a thought as most people can't sleep very well with 22 wires hooked up to them .... I slept great at home but I might add that I got up at 5:00 am the morning of my sleep study day( had my 3 cups of coffee) but, had no naps or iced tea just water for the rest of the day & night and worked my tail off around the house so I could sleep good for the study and I did even with the wires and tape ! Keep us posted on your results. Goodluck - Take Care

StillAnotherGuest · Post by **StillAnotherGuest** » Sat Sep 01, 2007 5:39 am

ozij wrote:Chest. 2000;118:353-359.)
© 2000 American College of Chest Physicians

http://www.chestjournal.org/cgi/content ... /118/2/353

That's a very interesting study, there, o., and a bunch of things jump out (like everything jumps out):

With Sleep Efficiencies in the 70s, elevated WASOs, huge Arousal Indexes and large number of Awakenings, Table 1 says that those are some pretty awful sleepers. Maybe

The sleep unit (that) is located in a pleasant, old refurbished one-story building...

isn't all that pleasant.

The lack of REM-dependent SDB is noteworthy. Maybe all the patients have some degree of Chemoreflex-Dependent Sleep Apnea (the CSDB/CompSAS moniker is on the move again). Probably all the REM-dependent OSA patients ended up in the treatment group.

The mean AHI only went from 12.3 to 15.5, but 20-something patients moved up on the severity scale.

Anyway, syd, going from an AHI of 0.0 (if there is literally no sleep apnea) to 55.4 is a real stretch, that has to be a scoring anomaly.

Or get out all the numbers, if you only slept for a very short time (the insomnia thing) that could skew the results.

What's the chance of getting the raw data from the second (AHI 55) study? What software did that one use? Maybe you can get some raw data printouts in the areas that have high concentrations of respiratory events.
SAG

StillAnotherGuest · Post by **StillAnotherGuest** » Sat Sep 01, 2007 6:01 am

Or, was the study that had the AHI 55 using a "pressure transducer" instead of a "thermistor" for event scoring?

Looking at arousal totals and sleep architecture may give an overall clue as to what's happening.

BTW, RLS is not really a sleep study thing, that diagnosis would be made by history.
SAG

Note to self: Trying to do an MSLT while on antidepressants.

mindy · Post by **mindy** » Sat Sep 01, 2007 8:52 am

Hi Syd,

No stage 3/4 and almost no REM sleep is what happened on my first night in the sleep lab. I had 1 central sleep apnea, no OSAs and the rest were all hypopneas with AHI overall 8.9 and AHI on back only 13.6. I rarely sleep well anywhere except home and felt like I had been awake most of the night. They said I wasn't really awake, just light sleep.

I asked the sleep lab doc about how valid the study would be given the light sleep and she said they had done some experiments having people come in every night for about 4-5 days and did not get different results.

That said.... even though my results were mild, they decided to have me come in for a CPAP titration study since I have a heart condition. That time I took a higher dose of sleeping meds (Ambien) and slept like a baby. They ended up giving me a pressure range of 7-12 and I'm now seeing 90th percentile always in the 9.1 - 9.6 range. My AHI is still around 4-5 despite therapy.

So despite the unusual sleep pattern in the first study, it seemed to be consistent.

The morning after titration study my brain was much! less fuzzy than in a long time and after almost a month, I'm starting to feel a little less tired.

Luckily, I had the same sleep technician and same sleep doc for both studies.

I would guess that variation is definitely possible. If all those wires aren't placed exactly right, I'm under the impression that results can change. They carefully measured exactly where to put some of them.

Oh yes, and although I'm overweight, I have a friend who is as skinny as a rail (underweight) and has severe OSA. Go figure!

Mindy

Do I or don't I (have sleep apnea)?

Do I or don't I (have sleep apnea)?

Inconsistent results

Re: Do I or don't I (have sleep apnea)?

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