Oximetry reading

Hello everybody!

It's been a long time since I last posted or even read this forum.
I am still 100% compliant, 9 months after starting my treatment, and my average AHI is 0,3 over the past 7 days and 0,4 over the past 30 days
So, no problems for me!!

But I have a question about a colleague I recently started working with (although I did my studies with him 15 years ago, but lost contact). He is my age (34), ex-smoker (stopped smoking a bit less than a year ago after smoking for 15 years). I talked to him about my sleep apnea and he was very interested in hearing about it and I know understand why... He has a strong tendency to fall asleep in monotonous situations (we do a lot of flying in unpressurized aircraft and it is a joke among us that he usually falls asleep between the moment we start taxiing and the moment we take-off) and has told me he snores (although not when he falls asleep sitting up during the day).

I therefore lent him my recording oximeter for a night, here are the results (zoom on a 1 hour period then report summary):



What do you think of these results? What should I tell him?

(By the way, I am the pilot in this aircraft, I have a full professional pilot medical certificate (aka "class 1 medical"), I only need to prove during medical renewal that I am compliant and that residual AHI is under control - very good incentive to be 100% compliant )

First of all, 1 hour isn't much to go on, but let's just leave that open for now.

Overall, the O2 saturation looks good. Overall the pulse rate looks good.

There may have been an obstruction at 1:20 and another at 1:43, but it appears to have been quickly resolved.

Keeping in mind that sleep disorders have a wide variety of causes and that obstructive apnea is only one of the causes, it looks like obstructions are not a problem in this case. With that said, this does not rule out other issues that can interfere with getting a restful nights sleep.

Bluecat wrote: I therefore lent him my recording oximeter for a night, here are the results (zoom on a 1 hour period then report summary):



What do you think of these results? What should I tell him?

Hi Bluecat,

A couple of points I noted.

Normally, if given the "Total Events" and "Index (1/hr)" you can determine the length of the test.

So, 47 / 3.9 = 12 Hours and 3 Minutes - did he really test for that long ?

There is no drop below 88 % so no significant "Apnea" events - was he sleeping on his side or front?

There are slight (heart rate) arousals with his deep hypopnia's, so my take on this would be perhaps (assuming he was indeed on his back for a few hours at least) that he still may be having disturbed sleep (thus tired during the day) but is not having full obstructions.

For a person of his age, a "Basal Average" of 94.7 % seems pretty low to me (unless he was indeed at altitude) indicating perhaps poor quality breathing while sleeping. I am 24 years older and manage 98 % Basal overnight without CPAP.

That is my "amateur" and "newbie" take on the above oximeter results.

Regards , Geoff (New Zealand).

I'd be interested in seeing the whole night graph.

I think I have to disagree with the above posts.
While the SPo2 isn't going into dangerous areas, it shouldn't be moving about as much as it is.
It would be very interesting to see the entire nights data, but I suspect he does have moderate sleep apnea.
If so it would be far better to start treatment now, rather than wait for it to develop further.

Thanks for these answers, I will post the rest of the data when I get round to it (probably this evening, french time) (Edit: had some time available so added to this post! There are also a few times during the night where there were recording problems, probably due to him moving, the three big dips in Sp02 are in fact part of these). The test didn't last 12h, but he forgot to turn off the oximeter in the morning so there is quite some time of no data at the end (until I turned it off when I saw him at work in the morning). I chose that hour because I found it the most interesting (it gets better towards the end of the night).
Regarding basal Sp02, the average altitude around here is 350 ft above sea level, so I wouldn't say that is a factor. Probably having been a heavy smoker is one though!
I will ask him in which position he sleeps.

My guess is that the hour you posted he was in REM. It starts right at the one hour mark and is pulse is also eratic during that time. While his O2 is above 90 most of the time, he is probably having arousals that interfer with sleep stages. It could also be positional. I would suggest he have a sleep study.

Stair-step desaturations, for example at 1:02 and 1:10 look like what happens during an apnea event.

Even though the O2 sat doesn't get critically low, those are frequent enough to cause arousals and sleep deprivation.

With that record and his symptoms, he needs a sleep study.

I agree that a sleep study is indicated. I just wanted to point out, in response to the comments regarding desats. Just because he doesn't get below 88% saturation does not mean his desats aren't significant. The sleep study guidelines consider all desats that involve a drop of 3% or more significant.
Jamis

my oximeter has a setting to define what an "event" is, it would be useful to post that.

I was told to ignore those sharp spikes... but as above, these stair step events (elaboration on that I would appreciate - of what duration , for instance).

less than 90% O2 is considered "medcally significant", apart from those spikes I was told to ingore.

for me, I have not the benefit of the full data to link up the xPAP machines data to the oximeter.

some info here

http://www.amperordirect.com/pc/help-pu ... sults.html

Peterg, I have no idea what information you meant to provide in your post.
The OP's friend should have a sleep study.

I will have a (long) chat with him next week about this. Thanks for all your answers.

Lizistired wrote:Peterg, I have no idea what information you meant to provide in your post.
The OP's friend should have a sleep study.

basically that my graphs looked like that with spikes and < 2 min steps - some spikes way down - and my sleep specialist told me to ignore them.
I asked him what a bad grap would look like and he drew a sustained desat (I still a bit confused about what he was drawing though). I'd take a punt and say that the average person on the street would have a graph that looked like that.
if you;ve got more info on interpreting and what a problem or suspicious graph would look like, I'd appreciate it, as I am going to lend my O2 meter to a few people who don;t want to do sleep studies, but will let me put this on their wrist for a night.

still, I agree, if in doubt, have a sleep study.

peterg,

The sharp spikes up or down are usually artifacts due to movement. The stair-step decreases are typical for apneas.

Try this on yourself. Put on the oximeter and hold your breath for 2 minutes while watching the numbers (it won't be easy). You will see the O2 sat. decrease in a stairstep fashion. that's exactly what happened in the OP's friend's tracing.

Imagine the effect on your sleep and your body when that happens many times an hour.

Hi Peter,
Here is a whole night shot and an overlay of my O2 and ResScan data. After the 12 second obstructive apnea you can see that my flow increases and my O2 spikes. On the others it doesn't but goes back to about where it was. His seems to drop and spike repeatedly.
During my sleep study I only had 11 apneas an hour but had over 40 arousals an hour disrupting my sleep.