Cease CPAP Use Two Weeks before Sleep Study?

Tec5 · Post by **Tec5** » Wed Apr 27, 2022 9:01 am

Rubicon wrote: ↑
Wed Apr 27, 2022 2:25 am

I'm reviewing the posts on this thread (relating to cessation of treatment prior to a NPSG assessment). You posted a couple of graphs https://www.cpaptalk.com/viewtopic/t184 ... 0#p1410497
that appeared to demonstrate that AHI recovers rather quickly after a day or so. But I maybe misinterpreting the graphs.

Where did these graphs come from? (they don't seem to be in Lazaruz or ChicagoGranny's posts)
I'd like to find out more detail than just the graph with no explanation.
(perhaps I missed your citation)

Tec5 · Post by **Tec5** » Wed Apr 27, 2022 9:19 am

Rubicon wrote: ↑
Wed Apr 27, 2022 2:25 am
Frankly, I don't know how you don't see how this is pertinent.

As I said, the decision has already been made, the NPSG schedule has been made, the only question was interested in was the duration of CPAP treatment withdrawal to obtain an accurate assessment of SDB without interference of the active CPAP treatment.

Tec5 · Post by **Tec5** » Thu Apr 28, 2022 7:37 am

Back on Topic:
And then there's this:

Conclusion:
There is some evidence that CPAP washout exists in patients with a stable BMI throughout the follow-up period. However, the intensity and duration of this effect remains unclear. Within the limitations of the present study, it seems reasonable to maintain a washout period of 1 week, in case alternative treatments options are considered and especially when a baseline PSG (and subsequent repeat PSG after treatment) is needed in case of clinical trials.

CPAP washout prior to reevaluation polysomnography - 2015
https://link.springer.com/article/10.10 ... 014-1086-6

lazarus · Post by **lazarus** » Thu Apr 28, 2022 11:05 am

Sounds vaguely familiar somehow.

ChicagoGranny · Post by **ChicagoGranny** » Thu Apr 28, 2022 11:51 am

Tec5 wrote: ↑
Thu Apr 28, 2022 7:37 am
Back on Topic:
And then there's this:
Conclusion:
There is some evidence that CPAP washout exists in patients with a stable BMI throughout the follow-up period. However, the intensity and duration of this effect remains unclear. Within the limitations of the present study, it seems reasonable to maintain a washout period of 1 week, in case alternative treatments options are considered and especially when a baseline PSG (and subsequent repeat PSG after treatment) is needed in case of clinical trials.
CPAP washout prior to reevaluation polysomnography - 2015
https://link.springer.com/article/10.10 ... 014-1086-6

The key part of what you quoted is this:

in case alternative treatments options are considered and especially when a baseline PSG (and subsequent repeat PSG after treatment) is needed in case of clinical trials.

.

As I understand your case, neither of these items is applicable.

chunkyfrog · Post by **chunkyfrog** » Thu Apr 28, 2022 12:07 pm

Your insurance/HMO wants to STOP covering cpap treatment,
--in spite of the fact that apnea is no longer considered likely to "go away".
At least by doctors with a functioning brain.

lazarus · Post by **lazarus** » Thu Apr 28, 2022 2:07 pm

ChicagoGranny wrote: ↑
Thu Apr 28, 2022 11:51 am
As I understand your case, neither of these items is applicable.

Either options regarding treatment alternatives are being considered or this is merely a research experiment.

There really is no other reason for any medical test, is there?

Rubicon · Post by **Rubicon** » Thu Apr 28, 2022 3:44 pm

lazarus wrote: ↑
Thu Apr 28, 2022 11:05 am
Sounds vaguely familiar somehow.

Speaking of which, are you still upstate?

Bike Tour is this weekend y'know.

ChicagoGranny · Post by **ChicagoGranny** » Thu Apr 28, 2022 4:08 pm

lazarus wrote: ↑
Thu Apr 28, 2022 2:07 pm

ChicagoGranny wrote: ↑
Thu Apr 28, 2022 11:51 am
As I understand your case, neither of these items is applicable.
Either options regarding treatment alternatives are being considered or this is merely a research experiment.

There really is no other reason for any medical test, is there?

The most common reason for any medical test is to secure a diagnosis. The second most common reason is to measure the effectiveness of the current treatment(s). Alternative treatments and clinical trials (The study quoted says "clinical trials" not "research experiment," as you wrote.) are far down the list of reasons for a medical test.

Tec5 has previously stated in this thread the reason for a second diagnostic test:

Tec5 wrote: ↑
Mon Apr 25, 2022 5:34 pm
My doctor and I were not completely satisfied with the home study

lazarus · Post by **lazarus** » Thu Apr 28, 2022 4:37 pm

Thus the statement:

The purpose of this study is to evaluate the evidence on the existence and duration of this washout effect and its clinical relevance for current practice.

lazarus · Post by **lazarus** » Thu Apr 28, 2022 4:42 pm

Rubicon wrote: ↑
Thu Apr 28, 2022 3:44 pm

lazarus wrote: ↑
Thu Apr 28, 2022 11:05 am
Sounds vaguely familiar somehow.
Speaking of which, are you still upstate?

Bike Tour is this weekend y'know.

Oh, man. I was gonna drive into Brooklyn this weekend. Thanks for the heads up.

Yeah, still in Orange/Rockland.

ChicagoGranny · Post by **ChicagoGranny** » Thu Apr 28, 2022 4:52 pm

lazarus wrote: ↑
Thu Apr 28, 2022 4:37 pm
Thus the statement:

The purpose of this study is to evaluate the evidence on the existence and duration of this washout effect and its clinical relevance for current practice.

Yeah, that was the purpose of the study you keep quoting, but this was the conclusion:

However, the intensity and duration of this effect remains unclear.
https://link.springer.com/article/10.10 ... 014-1086-6

If the study did not determine either intensity or duration, it's worthless.

lazarus · Post by **lazarus** » Thu Apr 28, 2022 5:02 pm

ChicagoGranny wrote: ↑
Thu Apr 28, 2022 4:52 pm
study did not determine either intensity or duration

Basically one surgeon's assessment of other studies. His candor on the extent of the unknown and unknowable is what makes me appreciate it most.

Good thread. Thanks for it, my friend. And for putting up with me in it.

lazarus · Post by **lazarus** » Thu Apr 28, 2022 5:10 pm

Rubicon wrote: ↑
Wed Apr 27, 2022 2:56 am

Tec5 wrote: ↑
Tue Apr 26, 2022 11:33 am
Actually traditional Medicare and G supplement
Oh damn.

I'm curious again.

What scoring criteria was used in the home study?

Wait! Home studies actually have agreed-upon and variable criteria?

I'm even more out of date than I thought.

Rubicon · Post by **Rubicon** » Fri Apr 29, 2022 4:13 am

lazarus wrote: ↑
Thu Apr 28, 2022 5:10 pm

Rubicon wrote: ↑
Wed Apr 27, 2022 2:56 am
What scoring criteria was used in the home study?
Wait! Home studies actually have agreed-upon and variable criteria?

I'm even more out of date than I thought.

All PSG studies do. Hypopnea (a) and (b).

Cease CPAP Use Two Weeks before Sleep Study?

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