How much does your AHI vary?

My untreated AHI was only 13; but it was enough to profoundly affect my health.
I really wish avi would crawl back under his rock!

In the following report from 2009 co-authored by Dr Rapoport, the cut point for AHI to indicating SDB abnormality is below 15:


"currently accepted cutpoint for abnormality proposed by the American Academy of Sleep Medicine (AASM) and Centers for Medicare & Medicaid Services (CMS) in the US is an apnea-hypopnea index (AHI) ≥ 5 per hour but less than 15 per hour – but only if symptoms such as EDS are present."



Source:

How much sleep apnea is too much? Response
Rapoport, DM; Togo, F; Natelson, BH
2009 NOV ;11(4):778-778, Arthritis research & therapy
— id: 104883, year: 2009, vol: 11, page: 778, stat: Journal Article,

Saying that persons with AHI above 5 should go see a sleep doc is good for the doc's business.

It literally cracks me up at how biased your posts are. The study you just referenced states several factors, 1 that they are looking at a population with chronic fatigue syndrome, and 2 he is not looking at AHI, but rather RDI. He himself states that an AHI of 5 is significant, but given that RERAS can also contribute and in patients with chronic fatigue syndrome you may typically see more RERA's, he is choosing to use RDI. A CPAP machine cannot calculate RERA as it does not have an EEG attached to it nor respiratory effort sensors. So even if you wanted to use Rapoports RDI of 18, you couldn't with just a CPAP machine.

Secondly, an arbitrary cut off of AHI 5 would not necessarily apply to everyone. However, studies have shown that even mild OSA can impact QOL. Medicine is not simply a matter of cut off points. I have had patients whose sleep study revealed an AHI < 5 and still put them on a CPAP and they had significant improvement. Even the medicare guidelines state that you should treat OSA with AHI <15 but >5 if there are daytime symptoms present.

You made a blanket statement stating that anyone with an AHI < 20 should be fine. That is incorrect. It may be correct in select situations, but any person that comes on this forum and has a residual AHI > 5 should meet with their physician to determine if this is significant and requires attention or if it is something that can be monitored.

Also since you love David Rapoport so much, here is a list of other studies he has participated in revealing mild OSA treatment results in positive outcomes and withdrawal of CPAP even in mild OSA can have detrimental effects.

http://www.ncbi.nlm.nih.gov/pubmed/22837377
http://www.ncbi.nlm.nih.gov/pubmed/23449493

My AHI is 0.0 every night. I use a full face mask and maintain the rubbers; makes a huge difference.

OKCSleepDoc wrote:It literally cracks me up at how biased your posts are. The study you just referenced states several factors, 1 that they are looking at a population with chronic fatigue syndrome, and 2 he is not looking at AHI, but rather RDI. He himself states that an AHI of 5 is significant, but given that RERAS can also contribute and in patients with chronic fatigue syndrome you may typically see more RERA's, he is choosing to use RDI. A CPAP machine cannot calculate RERA as it does not have an EEG attached to it nor respiratory effort sensors. So even if you wanted to use Rapoports RDI of 18, you couldn't with just a CPAP machine.

Secondly, an arbitrary cut off of AHI 5 would not necessarily apply to everyone. However, studies have shown that even mild OSA can impact QOL. Medicine is not simply a matter of cut off points. I have had patients whose sleep study revealed an AHI < 5 and still put them on a CPAP and they had significant improvement. Even the medicare guidelines state that you should treat OSA with AHI <15 but >5 if there are daytime symptoms present.

You made a blanket statement stating that anyone with an AHI < 20 should be fine. That is incorrect. It may be correct in select situations, but any person that comes on this forum and has a residual AHI > 5 should meet with their physician to determine if this is significant and requires attention or if it is something that can be monitored.

Also since you love David Rapoport so much, here is a list of other studies he has participated in revealing mild OSA treatment results in positive outcomes and withdrawal of CPAP even in mild OSA can have detrimental effects.

http://www.ncbi.nlm.nih.gov/pubmed/22837377
http://www.ncbi.nlm.nih.gov/pubmed/23449493

OKSleepDoc,

Just an FYI, Avi has a history of posting these types of absurd messages that are not correct. No matter how much we have tried to refute them, it doesn't seem to help. But hopefully, even though I doubt he will listen to you, even with your credentials and this excellent post. hopefully, this will steer newcomers straight who might have been influenced by what he says.

We all greatly appreciate your contributions.

49er

LSAT wrote:

Country4ever wrote:Just curious. Within a week, how much does your AHI number vary? Some nights mine is higher (7-8), and then other nights, it will go down to 3-4. All conditions seem to be the same. Is that fluctuation normal?

Just a FYI...The Resmed S8 algorithm tends to overstate the HI. When I used an S8 my AHI averaged about 4-5. Once I switched to a S9 my AHI has averaged 2. No change in mask or anything else.

Does the S8 overstate or undertreat? I would think both are possible

OKCSleepDoc wrote:It literally cracks me up at how biased your posts are. The study you just referenced states several factors, 1 that they are looking at a population with chronic fatigue syndrome, and 2 he is not looking at AHI, but rather RDI. He himself states that an AHI of 5 is significant, but given that RERAS can also contribute and in patients with chronic fatigue syndrome you may typically see more RERA's, he is choosing to use RDI. A CPAP machine cannot calculate RERA as it does not have an EEG attached to it nor respiratory effort sensors. So even if you wanted to use Rapoports RDI of 18, you couldn't with just a CPAP machine.

Secondly, an arbitrary cut off of AHI 5 would not necessarily apply to everyone. However, studies have shown that even mild OSA can impact QOL. Medicine is not simply a matter of cut off points. I have had patients whose sleep study revealed an AHI < 5 and still put them on a CPAP and they had significant improvement. Even the medicare guidelines state that you should treat OSA with AHI <15 but >5 if there are daytime symptoms present.

`You made a blanket statement stating that anyone with an AHI < 20 should be fine. That is incorrect. It may be correct in select situations, but any person that comes on this forum and has a residual AHI > 5 should meet with their physician to determine if this is significant and requires attention or if it is something that can be monitored. ````````````````

Also since you love David Rapoport so much, here is a list of other studies he has participated in revealing mild OSA treatment results in positive outcomes and withdrawal of CPAP even in mild OSA can have detrimental effects.

http://www.ncbi.nlm.nih.gov/pubmed/22837377
http://www.ncbi.nlm.nih.gov/pubmed/23449493

Reply,

'I never made this statement: You made a blanket statement stating that anyone with an AHI < 20 should be fine.
I just showed what Dr David Rapaport stated on it. Dr David Rarpaport is amongst the top U.S. Sleep doctors. But since you hardly know his name it leads me to believe that you're a young rooky doctor.

You posted: I have had patients whose sleep study revealed an AHI < 5 and still put them on a CPAP and they had significant improvement. Even the medicare guidelines state that you should treat OSA with AHI <15 but >5 if there are daytime symptoms present.

Well, none of the sleep docs that I dealt with (locally about 3 in same town) did ever ask me about my AHI data. They only wanted to know how do I feel . For example, A doctor who holds MD in Internal medicine plus MD in pulmonology plus and MD in Sleep Medicine and being a classmate of Dr David Rapoport at NU Univ, refused to look at the reports from my home machine, saiyng that much of it can't be trusted. There never been a chance that I could show this Doc my data. Besides, this Doc believes only in Clinical Sleep Study results. On top of it, even if I told this doc that my AHIs have been between 10 and 15, nightly for the last 6 months, it would not interest him, and also would could he do. Prescribe a new sleep study after a sleep study, willy nilly, while Medicare would not pay for such frequent tests. And who would pay his time dealing with me beyond the 15 minutes. Another issue is that most Sleep Docs are not familiar with the operation of CPAP machines in APAP modes. The reason could be that sleep clinic don't test on machines in APAP modes. So Docs refrain from prescribing APAP machines such as the S9 Autoset, While we here in this forum like them a lot.

I'd love to be a fly on the wall during his office visits!

Dr OKC, thank you for posting that very informative reply, it's very helpful and easy to understand.

CREEKREDMAN wrote:I have central and obstructive sleep apnea. I was tested on cpap & bipap with o2. I failed cpap. somehow or other I recieved a cpap machine instead of bipap. My docs have tried to correct the error with medicare & resp. company to no avail. My ahi is running anywhere from 19.85-16.85 then sometimes to 5 or 6 then back up again. When the md wrote the RX for Bipap the o2 rep threw the RX at us & said go buy your own. the o2 rep. Proceeded to call Medicare. told them I was not complaint, medicare did not pay for the sleep study, & sleep study was not a cpap titration pollysomogram. After all this was proven false, now the o2 company calls Medicare & says I was never tested on Bipap. So I'm back to square 1. I see my neurologist tomorrow any help would be appreciated.

Hopefully by now you've started another thread so that your question doesn't get "lost in the sauce".

OKCSleepDoc wrote:

avi123 wrote:This is more from experience, but I have seen many patients who have seen another sleep doc, come in at 4-20, had residual AHI between 6-12 and I have optimized their settings and they come back, AHI is below 5 and they feel that they are sleeping significantly better.

Sorry, but I wouldn't want people out there to think that an AHI <20 is okay on their machine. If its Above 5, someone should look at why this is happening.

Question,

Should doctors be allowed to identify themselves as doctors but stay anonymous on social media, and in the media as a whole?

OKC is a sleep physician and kind enough to share his professional knowledge with us. Thank you.

I wish a member here would stop the insulting behavior! I used to think it was his untreated OSA that was causing his rudeness and bullying but now I think he is what he is!