Sleep study @12 AHI, but no cpap needed - Can this be right?

Perchancetodream wrote:Has he seen his doctor? When you say "they would just send him home," are you talking about the sleep lab?

The clinic that did our tests did not tell us anything about the results, only that our doctor's office would be in touch. It is up to the doctor to prescribe the therapy (or lack thereof) not the clinic.

If it were me, and my doctor refused to prescribe treatment, I would want to know why.

Susan

AHI greater than 15 with either polysomnography or in-home unattended sleep test, or
AHI greater than 10 using an in-home unattended sleep test with documented symptoms of OSAHS, or documented hypertension, ischemic heart disease, or history of stroke, or
AHI greater than 5 by polysomnography when accompanied by symptoms of OSAHS, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

The following signs and symptoms have been found by population studies employing logistic regression analysis to suggest significant risk for OSAHS:

Awakening with choking
Hypertension
Intense snoring
Large neck circumference
Male gender or postmenopausal females
Obesity
Reported apneas or choking by sleep partner
Resistant hypertension and/or atrial fibrillation
Daytime sleepiness*, especially with impairment of driving
*Sleepiness can be quantified with the Epworth Sleepiness Scale (see Appendix A in the original guideline document). A high score correlates with the level of sleepiness; however, a low score does not rule out the presence of daytime sleepiness.

Diagnosis of OSAHS?
Key Points:

The diagnostic definition of OSAHS is affected by the presence of signs and symptoms of disease.
The definition of apnea and hypopnea and their correlation with morbidity and mortality has received considerable attention and has been recently well summarized. The guideline developers believe that adoption of a standard consensus definition of apnea and hypopnea is essential to uniformity in diagnosis and treatment:

Apnea is defined as a cessation of airflow for at least 10 seconds. The event is obstructive if during apnea there is effort to breathe.
Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds with at least a 30% reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4% oxygen desaturation.
Using these definitions, a diagnosis of OSAHS can be confidently made when testing shows that the average number of episodes of apnea and hypopnea per hour of sleep, called the Apnea-Hypopnea Index (AHI), is:

AHI greater than 15 with either polysomnography or in-home unattended sleep test, or
AHI greater than 10 using an in-home unattended sleep test with documented symptoms of OSAHS, or documented hypertension, ischemic heart disease, or history of stroke, or
AHI greater than 5 by polysomnography when accompanied by symptoms of OSAHS, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.For patients with symptoms suggestive of OSAHS and negative initial sleep tests, further diagnostic testing may be needed to determine the underlying cause of the symptoms, and referral to an accredited sleep center or sleep specialist is recommended.

It should be noted that these standards specifically relate to measurements made during full polysomnography with a denominator of hours of sleep. Although there are not yet well developed efficacy studies, in the opinion of the panel, when using a cardiorespiratory monitor, the lower limit of normal for the AHI should be 10 when combined with symptoms of OSAHS, using the same criteria for apnea and hypopnea specified above.

The severity of OSAHS is determined by symptoms, frequency of obstructions, and degree of desaturation.
The severity of the OSAHS is determined by the most severe rating of three domains: sleepiness, respiratory disturbance (AHI), and gas exchange abnormalities (minimum and mean oxygen saturation). The following can serve as a guide:

Sleepiness:
Mild: Describes sleepiness present only when sedentary or when little attention is required, and may not be present every day. Such sleepiness produces only minor impairment of social or occupational function. As a guide, an Epworth Sleepiness Scale result might be less than 12.
Moderate: Describes daily sleepiness that occurs when minimally active and a moderate degree of attention (e.g., driving, attending meetings or movies). As a guide, an Epworth Sleepiness Scale result might be 13 to 17.
Severe: Describes daily sleepiness during active tasks or tasks that require significant attention. Examples might include driving, conversation, eating or walking, and usually sleepiness produces marked impairment of social or occupational function. As a guide, an Epworth Sleepiness Scale result might be 18 to 24.
(See Appendix A, "The Epworth Sleepiness Scale" in the original guideline document).

Gas exchange abnormalities:
Mild: Mean oxygen saturation remains greater than or equal to 90% and minimum remains greater than or equal to 85%.
Moderate: Mean oxygen saturation greater than or equal to 90% and minimum oxygen saturation greater than or equal to 70%.
Severe: Mean oxygen saturation less than 90%, or minimum oxygen saturation less than 70%.

Respiratory Disturbance:
Mild: AHI 6 to 20
Moderate: AHI 21 to 40
Severe: AHI greater than 40