AHI Question for Sleep study

original poster wrote:First off I am the "original guest" who posted this. I was told originally when I was diagnosed that a lot of my upper airway structures were swollen (ie uvuela, epiglottis) from turbulent airflow as a result of restriction caused by osa, I was diagnosed as *moderate*. I was afraid with xpap use, this swelling would go down, and I would turn up a very low AHI, and if I discontinued xpap use, it would start all over again, may take several days/weeks for the damage to recur.

I'm following you, woozle. When I read your original post..the one at the beginning of this thread...I thought you had probably had a diagnosis of "mild". (Definitions will be at the end of this post )

If you had had an AHI that barely put you in the treatable category of "mild", there could be a chance that long term cpap use had smoothed down any swelling that the snoring often associated as a symptom of OSA might have caused. Swelling which could have narrowed the airway more pre-CPAP than is the case now.

If your original study had placed you right on the dividing line between "no OSA" and very "mild" OSA worthy of insurance paying for treatment, I can certainly understand that you'd be concerned that the slightest improvement in your airway (like not swollen while on cpap treatment) that might tip the scale back the other way by an AHI point or two could cause insurance to yank the machine from you.

But, with the "moderate" diagnosis you say you had from your original study, you should still easily get a "needs treatment" diagnosis from the next study, even if the throat tissues are less swollen now (on cpap treatment) and even if they could remain that way (not swollen) for a day or two without cpap.

A definition of mild-moderate-severe OSA

In this topic: http://www.apneasupport.org/viewtopic.php?p=10365

sleepydave wrote:
I like this format for sleep study interpretation, which takes into account 3 factors:

"Mild: An apnea-hypopnea index from 5 to 14. An oxygen saturation of at least 86%. Unwanted sleepines or involuntary sleep episodes occur during activities that require little attention. Examples inclue 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: An index from 15 to 30. An oxygen saturation of 80% to 85%. 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: An index greater than 30. An oxygen saturation of 79% or less. Unwanted sleepiness or involuntary sleep episodes occure during activies 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.

AHI and EDS references from:
Flemons WW. Sleep-related breathing disorder in adults: recommendations for syndrome definition and measurement techniques in clinical research.
Sleep 1999;22(5):667-89.[/b]

Thanks, SnoozeHunter. I was pretty sure there were at least a couple of people posting (as guests) on this thread.

(My apologies if I'm duplicating others ideas, but I haven't had a chance to re-read this whole thread this morning.)

I'm not sure what these "boneheads" at the insurance companies are thinking....that CPAP therapy is going to "cure" your OSA? If (any of) you were originally diagnosed with OSA, you're probably always going to have it. If you go off of therapy, it WILL come back....sooner or later.....depending on the severity and other physical factors. I also have a hard time believing that the insurance provider would want to be held legally responsible if they discontinued providing you with the equipment and you fell asleep at the wheel and became a "statistic" (like the one that mousetater posted this morning)......running over a pedestrian. You might ask them if they want to be responsible for something like THAT.

Original Poster,

If they're going to REQUIRE an additional sleep study, that should also show whether you're have any blood oxygen desaturations.....(which could also be done in an overnight pulse/ox study without having to do a complete sleep study and wouldn't cost a thing).

You've indicated you're planning on getting an APAP.....good idea! Just make sure that you have your prescription so you can get what you want. You might check with your insurance provider and see if they'll reimburse you for your equipment if you purchase it out-of-pocket. Tell your insurance provider how much you're going to save them.

Best wishes,

Den

Den,

Great suggestion on the pulse-ox at-home study if that's what they're looking to see.

Your post just rang home about having an accident, heaven forbid, if they discontinue much needed therapy for OSA. Just now on a local news channel, I heard a trailer for an upcoming story about a 15-year-old girl being killed by a driver that is presumed to have OSA who fell asleep at the wheel. Will have to watch the full story on that to see the details. How incredibly tragic. I would pray the insurance companies take that into consideration before their bottom line when they think about discontinuing someone's treatment options for something as serious as this.

Wulfman wrote:I'm not sure what these "boneheads" at the insurance companies are thinking....that CPAP therapy is going to "cure" your OSA?

LOL, Wulfman...my thought, too. Some insurance companies will try every way possible to wiggle out of paying for treatments or wear the person out with red tape until the person gives up trying to prove a genuine health problem that's covered.

Not much regarding the way insurance handles OSA and the treatment for it makes sense.

Was able to get the full article/details on the web site for News 12, our local news channel here on Long Island:

(I had way too many interuptions trying to get that previous post finished)

Lori,

I read the thread that "mousetater" started about the accident and made a post to it, too.

Like I said in that thread, it would be interesting to know how "compliant" (not) that driver was.....how long he'd (supposedly) been on therapy.....who was monitoring his compliance (obviously one of those high-priced DMEs and/or sleep doctor).....what equipment he was supposed to be using, etc., etc., etc. (the "unknowns")

Den

Sleepless on LI wrote:Using cpap doesn't prevent you from having events when you don't use it the following night. It shouldn't make any difference if you use it the night before you go for your new PSG. I wouldn't worry about that.

Actually, it can make a difference. There is a proven residual benefit to using cpap which could alter the data recorded in a sleep study. It makes perfect sense to discontinue cpap use for at least one night prior to a PSG in order to obtain the most accurate results.

The paper by HERS et al. in this issue of the
Journal provides important information on what happens
to OSA in that part of the night without effective NCPAP
therapy, and demonstrates a clinically important residual
benefit which persists in the latter part of the night
after NCPAP withdrawal. The frequency of apnoeas
and hypopnoeas was almost halved, and the severity of
oxygen desaturations greatly reduced, when compared
with the latter part of a previous study night without
NCPAP therapy. Furthermore, movement arousals were
fewer, despite the fact that sleep stages were similar
between the two study periods of therapy.

http://erj.ersjournals.com/cgi/reprint/10/5/969.pdf

Anonymous wrote:Now my question is as a 100% compliant user, before I go for a non-cpap (baseline) study, does it make a difference in results if I do not sleep with cpap for a day or more before the study, or is it ok to sleep with cpap the night before the study. Just want to make sure I dont end up with a very low ahi as a result of compliant long term use.

Based on the evidence, I'd suggest abstaining from using cpap at least the night before your PSG. Residual benefit will decrease in the absence of cpap, which will result in a more accurate reading.

Question for the Original Poster:

Is this follow-up sleep study supposed to be WITH or WITHOUT your CPAP equipment? (I don't know if that was plainly stipulated in any of the posts)

Excuse me, but I'm having a problem understanding where your insurance provider is coming from on this.

I could understand (sort of) if they want another sleep WITH your equipment......to see if it is actually set up and has been working properly for you.....but I do NOT understand why they would want another sleep study without it. It seems like they are challenging the original study and they don't believe you have OSA.

Maybe I've been sucking in too much smoke lately, but something sounds weird about this.

Best wishes,

Den

Veracious,

Thanks for the article. I'm going by what people have told me regarding their symptoms coming right back if they don't use their machines for as much as a half a night (one person) and one night (someone else).

There are all sorts of studies that contradict one another, so for every one that says this, you will probably find another that says the opposite. I'm not saying it's right or wrong. I'm certainly in no position to make that call.

I think the key here is, if the person going for the PSG feels by not using it the night before their results will be worse, and they feel it's that important or crucial for them to not use their machine for a night or two before their test, God bless them, don't use it. Personally, I wouldn't stop if it meant my health for so much as one night, test or no test. I believe in what is meant to happen, happens. If you are meant to be on therapy due to genuinely having OSA, and you have a reputable sleep center doing your PSG, it should show those results. I just can't see one night making a difference so that it appears you don't have something that you do. Yes, I'm sure certain deliberately induced factors, such as laying on your back or taking certain substances, be it alcohol or certain prescriptions, can make your AHI higher. But I wouldn't personally want to play that game.

Sleepless on LI,

You're welcome. It isn't often in this field where we can so easily reference verifiable scientific data to answer a question. It seems we must often resort to collecting individual opinions and guesses; none of which may be correct. In this case, we are fortunate to be able to offer a factual answer regarding the residual benefit of cpap therapy and it's effect on AHI, so we aren't forced to rely upon conjecture, or what we've heard, or our personal feelings on the subject. It is gratifying to know, in this case, there is an actual answer; not as a matter of opinion, but as a matter of fact. If only that were true more often in the study of SDB.