Post-Surgery Blues: Scoring Question

Briefly, to hit on the points raised in the previous few posts:

• As regards sleep hygiene, I've made a number of improvements on that front, but have seen little change in the quality of my sleep.
• I have the copy of the report. My lowest desats were around 86%.
• My last serious CPAP use was about a year ago. I couldn't handle the decreased sleep/rest quality while on it and still get through my long days. I waited until summer, when I had a break, to do the surgery.
• My CPAP machine is the PR System One. My ASV is made by PR too, but it's the pre-System One was that is bulkier and noisier. I did hook up the CPAP last night. Not surprisingly, ugh.
• I have basically stopped using sleep aids, and have done so for a period of several months. Their use is extremely infrequent now. In fact, I used no Ambien, Clonopin, etc. in this most recent sleep study, which was a first. (Stanford is good about letting you to to bed and wake up at your normal time, which for me is late; the previous clinic wanted lights out much earlier, which was rough.)

My brother-in-law had the identical surgery 10 years ago at UC-DAVIS (close to Stanford). He refused to try CPAP saying he was claustrophobic with mask on face. His sleep apnea and snoring just got WORSE. Now 10 years later, he regrets ever having the surgery but still refuses CPAP.

SleepingUgly wrote:My own doctor says interrater reliability in scoring arousals is pretty poor, and while I have no proof, I would bet my bottom dollar that a Stanford technician relative to say a Connecticut technician are going to get VERY poor interrater reliability.

If you look at a lot of the graphs posted here, or my own graphs, there's a lot of questionable grades made by the CPAP machines on "iffy" apneas or hypopneas. It's not really that cut and dried.

However, don't forget that a lot of apneas or hypopneas are not all all "iffy". If you've got a score of 66, you probably have apnea pretty bad, no matter who's doing the scoring. Maybe it really "should" be 40, not 66, but the extra 26 events probably weren't nothing, they were just cases where the apnea was in the gray area between apnea and no apnea.

Clearly the OP has OSA. I'm just saying that we can't say with any certainty that his OSA has worsened, and that it worsened due to the surgeries he had.

BrianinTN wrote:As regards sleep hygiene, I've made a number of improvements on that front, but have seen little change in the quality of my sleep.

Feel like making a sleep and food log?

BrianinTN wrote:I have the copy of the report.

Want to post that? Let's see what (if anything) is new.

Apnea and Hyponeas are easy to score and rules are obvious. The interpretation problems come when RERAs are include to computer an RDI. You don't need to discern an arousal for apnea or hyponea. Just don't take a breath for at least 10 second. If respiratory effort is absent during that time (no muscle movement in chest/abdomen), then it's a central apnea. It's easy for sleep clinic to score just apneas and hyponeas. RERAs are difficult. That's why Medicare does not allow RERAs or RDI to be used to determine whether a person needs CPAP.

Hi Brian,
Thanks for sharing your story with us. I'm sure someone out there will benefit from your story. A quick question...do you "feel" any different after the surgery? Regarding your sleep..do you feel more rested in the morning or do you feel the same or worse? I would imagine that an AHI of 66 would make you feel pretty tired.

Good Luck!

I had to look up with a mollete was.

teachcsg wrote:Hi Brian,
Thanks for sharing your story with us. I'm sure someone out there will benefit from your story. A quick question...do you "feel" any different after the surgery? Regarding your sleep..do you feel more rested in the morning or do you feel the same or worse? I would imagine that an AHI of 66 would make you feel pretty tired.

Thanks for asking. I actually feel no different than before surgery, which is why the results weren't really a surprise to me. I'm pretty tired and unmotivated most of the time, but no more so than before.

On an interesting side note, whereas I'd had LOTS of PLMs scored in my previous four studies, none showed up in this most recent one. I'm curious whether I just had a "good" leg night, or whether there might be scoring issues associated with different clinics and those?

mollete wrote:

BrianinTN wrote:As regards sleep hygiene, I've made a number of improvements on that front, but have seen little change in the quality of my sleep.

Feel like making a sleep and food log?

BrianinTN wrote:I have the copy of the report.

Want to post that? Let's see what (if anything) is new.

Yeah, I'll do it when I get back from this weekend. And resume logging at that time too. The food angle isn't great, but the sleep is more regular and has less of the usual culprits (e.g., backlighting before bed, etc.).

SleepingUgly wrote:I had to look up with a mollete was.

Pretty funny, huh?

mollete wrote:

SleepingUgly wrote:I had to look up with a mollete was.

Pretty funny, huh?

It's a muffin, right? Otherwise a Mexican dish or Spanish bread. Trying to make those of us on a low carb diet hungry??

I doubled the "t" also, and came up with images of clothespins.

I spoke to my ENT and there's no reason why I would have been "cured" post-surgery and then relapsed. She gave me no steroids post op and I was only on antibiotics. So maybe it was a placebo effect, despite the fact that I had no expectation of a cure.

I believe they use Alice. If you can get a copy of the scored raw data I can take a look at it for you if you're comfortable with that.

I used to do scoring for Stanford in their APPLES research project. Now for major hospital as well as small private labs. I score 95% + consistently in the AASM inner scorer reliability monthly testing. Resume to follow! J/K.

There really isn't as much subjectivity to it as many believe. There are very clearly defined rules for scoring. Some are just better/more experienced than others. If you want another set of eyes I'd be happy to take a look.

(Stanford would be considered "liberal" with scoring because they use hypopnea rule 4b.).