Patrol the hospital halls

colomom wrote: ↑

Sun Oct 23, 2022 9:38 am

Much in sleep medicine is based in old thinking and old research that excluded woman due to the erroneous assumption that OSA only impacts men.

Unfounded generalization.

colomom wrote: ↑

Sun Oct 23, 2022 9:38 am

As I said before STOPBANG could be improved. Another example is that menopause, pregnancy, and PCOS dramatically increase a woman’s likelihood of having OSA, yet none of these are considered in the most common OSA questionnaires that are given to women.

And as I said before, what do you suggest? It has to be a screening tool, so if you make it 7 pages long it won't work.

And keep in mind that a screening tool is not a diagnostic tool, and won't be no matter how many pages it is.

colomom wrote: ↑

Fri Oct 21, 2022 12:28 pm

I told my PCP the story about a sleep tech suspecting my OSA, but she thought it unlikely that a healthy 110 pound woman could have OSA. Fortunately after dealing with my son’s struggles I knew a bit about OSA was able to talk her into overnight oximetry

Good thing RS(1) didn't talk her PCP into overnight oximetry to "screen" for OSA. They would have missed the boat entirely.

The oximetry showed that my O2 was <88% for 4.5 hours but I remember the Pulmonologist asking me to rethink my answers to the Epworth questions saying that because my STOPBANG score was low my insurance would likely want to see a really high Epworth score to pay for a PSG. After a home PSG I was diagnosed with moderate OSA, the low O2 was most concerning me.

I would say. And actually, that doesn't sound like vanilla OSA to me either.

Rubicon wrote: ↑

Sun Oct 23, 2022 10:21 am

It was.
Now they call it Berlin.

Wish the docs I’ve seen used Berlin, looks better to me.

Rubicon wrote: ↑

Sun Oct 23, 2022 10:21 am

And as I said before, what do you suggest? It has to be a screening tool, so if you make it 7 pages long it won't work. And keep in mind that a screening tool is not a diagnostic tool, and won't be no matter how many pages

I am not a doctor but as I said before, I think more weight should be given to things like snoring, gasping, and observed pauses in breathing. I also think the male specific criteria could be at minimum revised. Neck size could be a male with 40cm neck or if female whatever measurement would be significant for a woman’s often smaller bone structure. It could be one point for being male or a point if you are female and are either pregnant, Perimenopausal, menopausal, or have PCOS.

Rubicon wrote: ↑

Sun Oct 23, 2022 10:21 am

Good thing RS(1) didn't talk her PCP into overnight oximetry to "screen" for OSA. They would have missed the boat entirely.

You’re right, but oximetry was the only option my PCP was willing to do for me so I figured better than nothing. I imagine that for robysue1 and many others oximetry alone would likely give false negatives. Add to that for many including myself insurance often will only green light a home PSG, which likely underestimates the problem in many people.

Rubicon wrote: ↑

Sun Oct 23, 2022 10:21 am

I would say. And actually, that doesn't sound like vanilla OSA to me either.

Who knows, the home PSG that I had doesn’t offer detailed enough information to know whether or not my OSA is vanilla. My son got lucky when he got a traveling tech for one of his local sleep studies at our small hospital. The tech was incredibly knowledgeable. She told us that at her hospital they test for UARS and AHI alone doesn’t always tell the full story. She said she was seeing lots of airway restriction that didn’t meet the criteria for apneas and hypopnea but was likely a reason his O2 was so low even after they got his AHI under 5. Just a guess but maybe something similar could explain why my O2 was so bad. I did insist that my sleep doc do overnight oximetry after I had been using my APAP for a few weeks and my O2 was OK with APAP considering that I live at high elevation.

Bottom line for me is I think both screening and education of general practitioners should be improved. Over the last 2 years I’ve talked 4 relatives into getting sleep studies 3 were shown to have severe OSA and 1 had mild. My mother was having horrible symptoms when she would wake up in the morning including pale skin, headaches, and big BP spikes. Her doc simply told her to move to a lower elevation. When both she and the doc were talked into a sleep study it showed she had severe sleep apnea, she now uses APAP +O2. Sister in Law was put on nocturnal O2 because of a medical problem, but they couldn’t get her nocturnal O2 up enough. She had classic OSA symptoms including waking up gasping, but her doctors never suggested a PSG. Fortunately I talked her into pushing for it and now that she is using an APAP +O2 her nighttime oxygen is good.
My brother is the mild case. His snoring is so bad that his wife has to sleep in a separate room, but my brother hates the idea of being hooked up to a machine and refuses to try CPAP. While the concept of patients being their own advocates is great, when it comes to OSA the reality is few will advocate for a doc to investigate a OSA because they don’t want to believe they have OSA. With all the health issues OSA can cause, I think the medical profession needs to do a better job of identifying possible OSA sufferers.

Rubicon wrote: ↑

Fri Oct 21, 2022 9:14 am

D.H. wrote: ↑

Fri Oct 21, 2022 9:02 am

This might be controversial, but I think it's time!

Each hospital needs to have somebody patrolling the halls listening for snorers. While not everybody who snores has Sleep Apnea and not everybody who has Sleep Apnea snores, there is a strong correlation.

That's usually taken care of on intake. And absolutely anytime anesthesia will be involved.

The bigger issue is that river in Egypt.

If anesthesia is not needed, this screening is generally not done. Most patients are not asleep when admitted.

Okie bipap wrote: ↑

Fri Oct 21, 2022 12:04 pm

I was originally identified as possibly having sleep apnea during a hospital stay. The nurses noticed my blood oxygen level dropped quite a bit when I slept. The doctor who did the morning rounds prescribed my sleep study that confirmed it.

In your case they did what I suggested; or close to it!

robysue1 wrote: ↑

Sat Oct 22, 2022 9:16 am

. . .

My own insurance company didn't care which way the hypopneas were scored and the RDI = 23.1 was more than enough to get them to pay for their 50% of the cost of the machine. (Yes, my otherwise stellar insurance company has really lousy 'coverage" of CPAP supplies. I could have switched to a different company under my employer's open enrollment periods, but while the other company has better coverage for CPAP, it's problematic in many other ways.)

I think that we're plagued by patients who are undiagnosed or unable/unwilling to use CPAP; not patients using one unnecessarily!

Rubicon wrote: ↑

Sun Oct 23, 2022 10:55 am

colomom wrote: ↑

Fri Oct 21, 2022 12:28 pm

I told my PCP the story about a sleep tech suspecting my OSA, but she thought it unlikely that a healthy 110 pound woman could have OSA. Fortunately after dealing with my son’s struggles I knew a bit about OSA was able to talk her into overnight oximetry

Good thing RS(1) didn't talk her PCP into overnight oximetry to "screen" for OSA. They would have missed the boat entirely.

As I recall, the conversation with my PCP went something like this at an annual physical exam:

Me: My husband says I snore and that I sometimes quit breathing at night. He thinks I need a sleep test because he's worried I have sleep apnea.

PCP: OK, let's get you a script for a sleep test. And that should be a higher priority than the referral to the ENT for the vertigo spells you say you're having, the rheumatologist for the hand & foot pain you are experiencing, or the mammogram that you are a bit overdue for.

I'll repeat my original 2 cents: Seems to me that "witnessed apneas" ought to weigh a whole, whole lot more than being male or being overweight in STOPBANG.

I'll add another 2 cents: Seems to me that "witnessed apneas" ought to put you on a direct line to NPSG

Back in the 80's I had a morning out patient surgical procedure for which I was expected to be in recovery and hour or two to wake up then be released. Wasn't released till late that evening. Nurse said they couldn't keep my oxygen level up, that I scared them because it kept dropping. Not sure when medical professionals were trained to recognize OSA, but it was not soon enough for me.

D.H. wrote: ↑

Sun Oct 23, 2022 4:33 pm

If anesthesia is not needed, this screening is generally not done.

What does that mean "Generally not done"?

Call up your hospital and ask for Nursing Education. Tell them you're a sleep apnea patient and advocate. Ask them if they have/use tools to assess sleep and/or sleep apnea on inpatient and/or outpatient admissions.

kteague wrote: ↑

Mon Oct 24, 2022 2:35 am

Not sure when medical professionals were trained to recognize OSA, but it was not soon enough for me.

I think it was in the early 90's when the Windows-based NPSG systems came out that things really started to pick up steam.

robysue1 wrote: ↑

Sun Oct 23, 2022 9:27 pm

I'll add another 2 cents: Seems to me that "witnessed apneas" ought to put you on a direct line to NPSG

Wasn't it me who said that?

D.H. wrote: ↑

Sun Oct 23, 2022 7:49 pm

robysue1 wrote: ↑

Sat Oct 22, 2022 9:16 am

. . .

My own insurance company didn't care which way the hypopneas were scored and the RDI = 23.1 was more than enough to get them to pay for their 50% of the cost of the machine. (Yes, my otherwise stellar insurance company has really lousy 'coverage" of CPAP supplies. I could have switched to a different company under my employer's open enrollment periods, but while the other company has better coverage for CPAP, it's problematic in many other ways.)

I think that we're plagued by patients who are undiagnosed or unable/unwilling to use CPAP; not patients using one unnecessarily!

The problem of sleep apnea diagnosis and treatment is not unique. Research hypertension. It's worse.

colomom wrote: ↑

Sun Oct 23, 2022 1:27 pm

Bottom line for me is I think both screening and education of general practitioners should be improved. ...

With all the health issues OSA can cause, I think the medical profession needs to do a better job of identifying possible OSA sufferers.

I think where we're at now is where we'll stay.

Appreciate the anecdotal stories but that ain't what drives the boat.

Scientific papers are mostly about forests; forum posts are mostly about trees. But boats are mostly for rocking, baby, yeah!

All I know is that the last time I patrolled the halls of a hospital, I was walking slow, pushing a drip, and wearing a funny gown that opened at the back.

Good times!