Bradycardia 29

Hello - I am looking for some suggestions for a friend that recently had a home sleep study. I am a long time successful cpap user but this situation is new to me.

The sleep study indicated severe OSA with pAHI of 29 the first night and 41 the second night. It was a two night study using a NightOwl sensor. The telemed Dr. made a written diagnosis of OSA and stated that is was moderate to severe. But they declined to prescribe APAP because of bradycardia during the sleep test. There was apparently a reading as low as 29, but the mean is still 61/62. The results show a "percent BPM <40" as 0% for each night. Which I am thinking means that the 29 BPM reading that it says it got at some point must account for less than 1% of the overall. This was a board certified sleep medicine MD.

The suggestion the dr made is to make an appointment for an in person office visit with a local sleep doctor. She has no insurance so a full PSG is likely off the table. I did some quick checks and it looks like an appointment would be weeks away if not months...if she can find a way to pay for it. She is discouraged and shutting down. I know from my own experience years ago that she is probably not able to process all this well in her current state of sleepiness. But it's too important to just let it go.

I've done some searches and it seems like bradycardia is often found with people with OSA. I'm not sure that it should be unexpected or unusual. It often goes away with successful APAP treatment. So I am confused by the doctor's response. I know NightOwl uses an AI to automate and pre-evaluate the results. Maybe this doctor just accepted the pro forma result from the AI without actually spending any time to see if he could do better. Or maybe this is just the level of care you get with a home sleep study.

I am considering just providing her with my retired but functioning APAP and a new mask. It's high mileage but working fine as far as I know. A Respironics M-series auto.

Thoughts?

madcity cpap wrote: ↑

Tue Nov 02, 2021 3:39 pm

The suggestion the dr made is to make an appointment for an in person office visit with a local sleep doctor. She has no insurance so a full PSG is likely off the table.

Does she have a family doctor? Ask the doctor to write an order for an overnight pulse-oximetry study. Many DMEs provide the equipment and a report to the doctor free of charge. This will give an idea about bradycardia or no bradycardia. Depending on the results, the doctor could write a prescription for CPAP.

madcity cpap wrote: ↑

Tue Nov 02, 2021 3:39 pm

I am considering just providing her with my retired but functioning APAP and a new mask. It's high mileage but working fine as far as I know. A Respironics M-series auto.

If you use OSCAR, I see no harm in doing this. It does leave the issue of bradycardia open.

It's possible the internet doctor misinterpreted the study.

A HR of 29 is concerning. Heart rates that low are rarely sinus rhythms. Usually they're high-grade AV blocks requiring a pacemaker.

However, I have seen people have vagal responses where their HR gets that low. How long was her HR that low?

southerndoc wrote: ↑

Tue Nov 02, 2021 3:57 pm

How long was her HR that low?

As far as I can tell, it was momentary. The report showed a low of 29 but the percentage of time below 40 BPM still came out to 0%. So if I am reading that right, it was never below 40 BPM long enough for it to register as any measurable % of the night.

ChicagoGranny wrote: ↑

Tue Nov 02, 2021 3:54 pm

Does she have a family doctor? Ask the doctor to write an order for an overnight pulse-oximetry study. Many DMEs provide the equipment and a report to the doctor free of charge. This will give an idea about bradycardia or no bradycardia. Depending on the results, the doctor could write a prescription for CPAP.

madcity cpap wrote: ↑

Tue Nov 02, 2021 3:39 pm

I am considering just providing her with my retired but functioning APAP and a new mask. It's high mileage but working fine as far as I know. A Respironics M-series auto.

If you use OSCAR, I see no harm in doing this. It does leave the issue of bradycardia open.

It's possible the internet doctor misinterpreted the study.

This is good to know that some DMEs will loan the equipment. She is actually meeting with her GP tomorrow. Unclear where that will go. Her provider organization tries to maximize rather than minimize the out of pocket cost but her actual dr may be sympathetic. They own the DME here.
The sensor did measure SPO2 and pulse continuously all night both nights she has that data. It appears that pulse graph shows fluctuations mainly between 48 and 72 with the bulk between 56 and 64. The summary page for the first night says it detected a low reading of 29 bpm at some point but the graphs don't show that dip. The second night is overall similar but drops only to 38bpm as a low. The SPO2 summary data for night onw says it dropped as low as 84% and reached a high of 98%. It also lists T90 of 6%. Night two shows a low of 82%, high of 100%, and T90 of 11%.

I am not familiar with T90. Can someone summarize what that is?

ChicagoGranny wrote: ↑

Tue Nov 02, 2021 3:54 pm

If you use OSCAR, I see no harm in doing this. It does leave the issue of bradycardia open.

Thanks for the reality check. It's great to have a few people to bounce this off of before I make the offer.

I do use OSCAR, but I don't think it will read data from this old machine. I have the smartcard reader and a copy of encore pro for it around here somewhere. Assuming I can get them installed on a current model PC I should be able to see something there anyway.

I also have my recently retired respironics system one APAP, but I prefer to leave that one offline as it's part of the recall. I am using resmed autoset 10 myself now.

?? Where did you see T90 in this thread?

No idea what it is either.

southerndoc wrote: ↑

Tue Nov 02, 2021 3:57 pm

A HR of 29 is concerning. Heart rates that low are rarely sinus rhythms. Usually they're high-grade AV blocks requiring a pacemaker.

Noted. I am not sure she is in a position to pursue it very far due to cost. But I will try to make the point.

Julie wrote: ↑

Tue Nov 02, 2021 4:35 pm

?? Where did you see T90 in this thread?

No idea what it is either.

It is listed on the sleep study report, in the SPO2 section. I have otherwise not seen it on the thread.

Please be aware that the Respironics M series machines are NOT compatible with OSCAR.
You do have some limited data on the M series LCD screen but no where near what OSCAR can show.

Pugsy wrote: ↑

Tue Nov 02, 2021 4:39 pm

Please be aware that the Respironics M series machines are NOT compatible with OSCAR.
You do have some limited data on the M series LCD screen but no where near what OSCAR can show.

Encore Plus shows a fair bit. Not as much as OSCAR, but there's some data there.

madcity cpap wrote: ↑

Tue Nov 02, 2021 4:45 pm

Pugsy wrote: ↑

Tue Nov 02, 2021 4:39 pm

Please be aware that the Respironics M series machines are NOT compatible with OSCAR.
You do have some limited data on the M series LCD screen but no where near what OSCAR can show.

Encore Plus shows a fair bit. Not as much as OSCAR, but there's some data there.

True and if you can use Encore you will have enough information to monitor things well enough.
I didn't mention it because I didn't know if you still had the card reader or not....those things are really hard to find and of course critical to using Encore.

Pugsy wrote: ↑

Tue Nov 02, 2021 4:54 pm

True and if you can use Encore you will have enough information to monitor things well enough.
I didn't mention it because I didn't know if you still had the card reader or not....those things are really hard to find and of course critical to using Encore.

Do I have it? I am certain I do.
Can I find it? I will let you know....

@southerndoc said:

A HR of 29 is concerning. Heart rates that low are rarely sinus rhythms. Usually they're high-grade AV blocks requiring a pacemaker.

My home sleep test documented a rate of 36 bpm at the lowest. A diagnosis of bradycardia is called out on the report. That did not stop my sleep doc from prescribing a machine but I've been evaluated by a cardiologist and maybe this should be her next step. As a newbie doing a lot of reading, I've only run across one example of a heart condition, and that condition involves Centrals & shouldn't use ASV--probably not relevant-- (ResMed press release)

https://aasm.org/special-safety-notice- ... t-failure/

but maybe the teledoc is being cautious for good reason.

madcity cpap wrote: ↑

Tue Nov 02, 2021 4:38 pm

Julie wrote: ↑

Tue Nov 02, 2021 4:35 pm

?? Where did you see T90 in this thread?

No idea what it is either.

It is listed on the sleep study report, in the SPO2 section. I have otherwise not seen it on the thread.

I found this definition for T90. If others can expand or add to it that would be great.

T90..."is the number of minutes during a night of sleep where the patient's oxygen saturation is 90% or lower"

It seems like this should be expressed in minutes, not percentage, so I'm not sure how all that gets reconciled.