Are my apnea events being accurately recorded?

[Rubicon]

The rules for desaturations are 4% for Medicare and 3% for most other insurers. At 29 years old I'm thinking Medicare isn't your primary insurer.

The 306 pulse events confirm the clinical significance of the 302 desaturations. IIWM I'd continue to use that criteria.

[Geer1]

I wasn't recommending using medicare cutoff going forward, AASM criteria makes more sense.

I was just curious to confirm the severity of desaturations in that data. From a glance most events appear to barely meet the 3% cutoff and I am guessing the 25 event index would drop down into single digits if using 4% cutoff. Imo this would confirm the desaturations although present are relatively mild and further support either a central or hypopnea dominant case.

[Rubicon]

 Imo this would confirm the desaturations although present are relatively mild and further support either a central or hypopnea dominant case.

The OP is 29 years old and didn't wear his CPAP.  Why would he have a central dominant case?

[Geer1]

It is less likely at younger age but possible. What phenomenon do you believe explains the nearly perfect periodic nature of SPO2 occurring from 16:55 onward?

I am curious to see if CPAP made the oximetry better or worse.

[Rubicon]

(Central) is less likely at younger age but possible. What phenomenon do you believe explains the nearly perfect periodic nature of SPO2 occurring from 16:55 onward?

The OP's original observations were

"someone who has been diagnosed with sleep apnea witnessed me sleeping and told me that I sound just like him while I'm sleeping (someone has recorded him sleeping before so he knows how he sounds) and he said he is as confident as can be that I have sleep apnea.'

so I don't think I'd be tossing around central in a youngster just yet.

OTOH, OSA can have periodicity, and is certainly far more likely.

That said, if you calculate the frequency of those events, he'd need an AHI of about 150!

So my turn again!

Do you think THAT'S possible? 

[Rubicon]

And please include scoring rules in your explanation.

TIA.

[vontheri]

Here is my most recent data with using both 3% and 4% as the cutoffs.  This is while I WAS using the CPAP.

   

   

Also, the is the data for the previous night (when I was NOT using the CPAP) using 4% instead of 3% (the screenshot with 3% data is in my previous post):

   

Thanks, all of you!

[Geer1]

I imagine that fluctuating SPO2 was periodic breathing of some sort. Unlikely to be apnea or hypopnea since the fluctuations weren't large enough to be desaturations and can't have been having arousals that often either. I just found it a bit odd and have a hard time thinking restriction could cause that consistent periodic fluctuation.

Regardless this oximetry report with CPAP shows no signs of apnea or fluctuation so it appears the CPAP helped treat/improve whatever was causing the desaturations and SPO2 fluctuations. More nights of data both with and without CPAP would be required to confirm one or the other weren't just good or bad nights and confirm that CPAP helps maintain more consistent SPO2.

I am curious what your CPAP data showed. If it indicates a lot of those apnea looking things for that night I think it is pretty safe to say you shouldn't trust the data or the program displaying it.

[Rubicon]

I imagine that fluctuating SPO2 was periodic breathing of some sort. Unlikely to be apnea or hypopnea since the fluctuations weren't large enough to be desaturations and can't have been having arousals that often either. ...

Regardless this oximetry report with CPAP shows no signs of apnea or fluctuation ...

Continuing to use the 3% desaturation rule, he still has 31 desaturations, so yes there are signs.

vontheri, can you post the waveform showing the periodic fluctuations again only this time with the 3% criteria?  In measuring pixels, I think a lot of those desats qualify, but if we have the technology, why not use it.

At any rate, you can't conclude that anyone has no apnea or hypopnea by looking at oximetry because neither requires a desaturation.

However, he could have been having arousals that often because the 306 pulse events give evidence of that.

At any rate, is your answer that he can't have AHI 150?

[Geer1]

Vontheri, I would like to apologize on both of our behalves for derailing your thread with pedantic bickering... In short the medical consensus is that ODI < 5 is considered to be normal hence my claim this recent data shows no signs of apnea [being an issue/out of normal range] unlike your data without CPAP which was significantly worse (although still not horrible).

To summarize my recommendations which have gotten lost in this mess my primary focus would be to get formally tested. Confirming oximetry is poor without CPAP and stable with CPAP confirms the CPAP is stabilizing your SPO2 and heart rate (assuming PR events also show improvement). With noticeable improvement like this I would expect you to also notice an improvement in your symptoms assuming they are caused by sleep disordered breathing. Symptoms often take weeks/months to get relief from because it takes a while for a person and their body to fully adapt to CPAP and recognize all of its benefits.

I wouldn't trust the data from your machine especially if it shows numerous events when SPO2 stays stable. At most you can try lowering or increasing the pressure to see if it changes the number of events you are seeing but I wouldn't monkey with settings much if the oximetry results continue to look this good. 

It is worth noting that they recommend discontinuing CPAP 3 days prior to a sleep study (I learned this during my first in clinic study...) in order to minimize its influence on the results. Just like how it takes time to adapt to CPAP it also takes time for your airway to degenerate without it. If you find CPAP helps I might be tempted to discontinue it for longer than 3 days in order to improve your chances of qualifying for insurance coverage.