Oxygen desaturations during sleep and potential problems

Hello,

I am 47.5 years old and was diagnosed at 43 with mixed sleep apnea. Severe palpitatios and heart pain during a basketball game led to a barrage of tests that did not reveal anything. I was perfectly healthy on paper. A few months later, after the described symptoms , I was diagnosed with Hashimotos but have remained euthyroid and Dr said that there is no need for thyroid hormones. I am 100% treatment compliant using the REsMed SV(?) machine; I observed an average AHI of 3 and an AI of .9 for the last three months. My complaint for the last few years has been palpitations/skips,heart pain and abdominal blotiness(due to VPAP air?).

A few days ago I bought a recording oximeter and noted that on 2 out of the last three nights my O2 lowest level was 84% and 72%. The third night the lowest O2 saturation was 90%. I believe that the O2 saturations of 72% and 84% were single events in the entire night and that the events lasted about 1-2 minutes each.

My question is this, what can I do to eliminate the low levels of O2 and what is the clinical significance of single events that last 1-2 on a nightly basis?

In addition I seem to have O2 saturations of 91-97 the rest of the night and the mean looks like it is 94%. My day readings of O2 saturation are 94-98% for the most part usually 94-95%.


Thank you

Complete heart work at Mayo clinic, including echo cardiogram , stress tests and cardiac catheterization, did not reveal any heat problems. I have only very minor

A person who doesn't have OSA usually doesn't go below the mid 90's.

You need to have a sleep test, the lower desats are dangerous.

I was diagnosed with mixed sleep apnea. How can I mitigate the times that O2 desaturations fall below 90%? I am already using a VPAP ASv machine. Is it as simple as raising the pressure? The machine is showing less than 1 AI per night.

Geraki wrote:I was diagnosed with mixed sleep apnea. How can I mitigate the times that O2 desaturations fall below 90%? I am already using a VPAP ASv machine. Is it as simple as raising the pressure? The machine is showing less than 1 AI per night.

It would be useful to obtain the Resmed ResScan software for your machine and to see what events are occurring around the same time as the events from your oximeter.

Where can I get the software? The manufacturer does not sell them as far as I know.


Thank you

Geraki wrote:Where can I get the software? The manufacturer does not sell them as far as I know.


Thank you

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Those sats are dangerously low and supposedly should not be happening if your SA is well-controlled by the xpap machine.

I would talk to your sleep physician--he or she should know about these desaturations. Clearly something is going on.

You might need a sleep study done while you are on the machine. That can give a lot more information than you can get off the machine data. There might be something totally different happening.

Geraki,
Janknitz is right, you may need another titration study. It's possible you are only having a couple of events per night causing those desaturations.

It's also possible that those low oxygen readings are what we call "artifact" in the sleep study world. That is an erroneous reading due to movement, the oximeter coming off, etc.

A trip to the sleep doc would be a good idea.

Thank you both for taking the time to respond to my questions. I called the lab and most likely will have another study in late August. I had the same thoughts, for example the VPAP machine showed AI of 0.1 and AHI of 1.8 last night and I noted a couple episodes on the recording oximeter that SPO2 desaturations went down as low as 84% and one at 70% while I was awake of close to rising. I think that something is up with the oximeter position during the night or that diffrent fingers produce diffrent SPO2 readings. In any case I will push for a sleep study.

I don't have time to read all of the replies this morning but you are probably getting good advice from those that have been on here for a while. Here is my experience and advice. Please READ IT CAREFULLY. YOU ARE IN SERIOUS DANGER.

I had H1N1 Swine Flu which produced the most severe case of bacterial pneumonia that they had seen in years. I was DEAD twice. Code Blue. Gone. Fortunately for me they brought me back and were given permission to use heroic and exceptional efforts to keep me alive. They succeeded and I will be forever grateful.

On returning home I found that I would wake up at night in a cold sweat with my heart pounding; my family doctor prescribed a sleep study immediately and I was in for one within a couple of days. The results? VERY mild OSA (maybe... there was like ONE instance of OSA during the night for about ten seconds). HOWEVER! Due to being on life support for three weeks my ability to suck in air was grossly diminished and when I fell asleep, between the position of my body and neck and the atrophied muscles in my diaghram not allowing sufficient air to get sucked in during deep sleep - my blood oxygen saturation would drop down into the seventies. ALARM! ALARM! This, I was told by TWO respirologists (both professors at the local medical school; one a professor emeritus) was causing my blood pressure to skyrocket (they don't necessarily measure this during a sleep study), my pulse rate to skyrocket and my heart to pump as hard as it could to get oxygen to my vital organs. The resultant risk of spontaneous death during sleep was high; heart attack, stroke, you name it. I was at the shop picking up my CPAP machine the very next day and returned for another sleep study during which my blood pressure WAS checked and an EKG hooked up as well. The whole nine yards. MUCH better. I no longer wake up in a sweat with a pounding heart. I started dreaming again and found myself more refreshed during the day and less prone to doze off after dinner before bedtime.

So, even if sleep apnea is NOT the cause of your issue, I am looking at SO2's of 70s and 80s and in MY brain sirens are going off. Red lights are flashing. YOU have the same end result symptoms that I had and I would not be at all surprised if you were at exactly the same risk that I was.

My ONLY piece of advice to you my friend (and on this board rest assured you are amongst friends with a common purpose) is to get yourself to a doctor IMMEDIATELY and be very proactive in insisting on an immediate sleep study with all of the bells and whistles. As far as I am concerned? You are at high risk at this point in time and should not be waiting a minute longer to seek assistance.

Good luck to you. I hope that you can get the diagnosis and the help that you need.

Thank you for taking the time to write to me. Your comments are really alarming to me. I have however been using a ResMEd ASV for about a year now. The AI are always less than one and the AHI has never gone above 2.8 for a night.

Given those stats how likely is it that I am experiencing true oxygen desaturations and not sleep "artifacts"? The longest desaturations, per the oximeter, have lasted 1.5 minutes and the oximeter has shown one or two instances per night that oxygen saturation has dropped to 84% and 70% for a given night. Wouldn't the VPAP machine record those as apneas? giving an AI of at leat two. I am only seing 0.1 per hour or is that just an average, which in this case would translate to 8hrs of sleep * 0.1 = approximately .8-1 apnea per night?

Does that even make sense to anyone? What is the clinical significance of having say single apneic events at night with O2 desaturations, down to 80%, that last for 1-1.5 minutes? Isn't that the same as holding your breath for 1.5 minutes while awake?

Ask your doc/sleep lab about borrowing one of their high-quality recording oximeters for a few nights...they record readings more often and fit more precisely/closely. My sleep doc uses the Nonins that are made for Respironics, the sensor fits into a tape (sorta like a bandage) that wraps around your finger...no chance of dislodging it during the night and the cord is extra long...reduces artifacts.