Are my apnea events being accurately recorded?

[Rubicon]

I neither bicker (I discuss) nor am Pedantic (Latvian, if it makes a difference).

However, to return to the discussion, in re:

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

Do you think THAT'S possible?"

I believe the answer is, astoundingly, YES!!

If we return to the strips initially presented, we see



In a 2 minute strip there are 4 apneas (I'm adding the 2 halves), so in this selection alone, AHI is 120!

Is oximetry good?  Good enough anyway.

Is his AHI good?  With 300+ cardiac arousals IMO sleep quality is not good.  At least locally he can run 100+ AHI so clearly present treatment is sub-therapeutic.

This is another case where epoch by epoch view with manual scoring is necessary for proper review.

[Rubicon]

And please include scoring rules in your explanation.

Yeah, this was kind of a red herring, because the answer is

"This is an internet forum!  We don't need no stinkin' rules!"

We only have a single channel to look at, so we need a surrogate to score hypopneas with arousals, and I think we should look at cardiac arousals.  Also, given the high AHI, there will probably be some short events (<10 seconds) that would not be picked up by the software (and there's a big problem here because this software hardly picks up anything).  But I mean, if you can convince me that a 9.5 second event is not a problem, and a 10.0 second is, by all means, convince away.  In a real NPSG the problem, if there is one, would be picked up in spontaneous arousals in EEG, but that isn't available here, so again we'll need to get creative.

[vontheri]

I appreciate that you all are taking interest and helping me figure out what is going on. I've been a bit preoccupied the last couple days as I have, after a few years of odd symptoms, finally tried to seek medical help to figure out what is going on. I have had some tests done which have shown some odd results. I had a blood test to measure my aldosterone and renin. My aldosterone is on the low end of normal and my renin is quite high (4 being the upper end of the reference range, and my renin is 26). I haven't been able to talk to the doctor who ordered that test yet but I'm wondering if I have some sort of neuroendocrine tumor such as pheochromocytoma or paraganglioma. I also had an echocardiogram which showed mild pulmonary valve regurgitation, and a renal artery ultrasound which was normal. I have severe anxiety and fatigue and high blood pressure as well as frequent hot flashes, which from what I have read are all symptoms of a neuroendocrine tumor, and high renin is a symptom and pulmonary valve regurgitation can be caused by neuroendocrine tumors. I'm sure that is probably outside the scope of this forum, however. I doubt that is related to my sleep apnea issues, assuming I truly do have sleep apnea. My sleep study is scheduled for April 7th.

I didn't get data last night but I am going to sleep right now and will use the cpap and the recording pulse oximeter. I have realized though that I really need to get a different mask as this one clearly does not fit properly around my nose and leaks right onto my eyes which is quite uncomfortable. I'm not really sure if my symptoms are affected by the cpap but it does seem as though I don't sleep quite as long when I use the cpap. I'm not sure if this is because my sleep is higher quality, thus I sleep less because I don't need as much sleep, or if it is because the discomfort of the cpap mask causes me to wake up and not sleep as long.

If it is relevant, I do wake up A LOT while I am trying to sleep. I wake up a minimum of a dozen times a night.

---

vontheri, can you post the waveform showing the periodic fluctuations again only this time with the 3% criteria?

Sorry, but I'm not sure exactly what you mean... I'm glad to post it, but I'm not yet familiar exactly with what the terms fully mean.  What exactly is it you want me to post?

[Rubicon]

Let's skip that for now and see what the sleep study shows. That should provide most of the answers and allow focused time on remaining questions.

[Rubicon]

That said, I found v2.3 of your software and should be able to help read your downloads if you feel like uploading that stuff to dropbox or similar. It looks like it's from "HUNAN VENTMED MEDICAL TECHNOLOGY CO., LTD." so this should prove to be quite an adventure, but I'd love to see why the reporting is so screwy. IDK any of the answers, nor even what most of the questions are, and it may turn out that in order to get any kind of benefit you might need to go to a brand name unit and software (if Oscar could be considered a "brand name"). At any rate, just throwing it out there.

Have to work around March Madness of course!

[Geer1]

My sleep study is scheduled for April 7th.  

Perfect, glad you were able to expedite that process. 

What type of study? Basic home study, level 2 home study (adds some eeg and emg monitoring) or in clinic?

[vontheri]

I will upload everything to dropbox soon.  The sleep study will be a polysomnagramn in a sleep lab.  At first she was going to just prescribe a home sleep study, but I was insistent on a polysomnogram.  I will make sure I don't use the cpap for a few nights before the sleep study.

Here is the pulseox data from last night, using bot 3% and 4%.  By the way, what is the significance of the PR events and in what way, if any, are they related to sleep apnea?

       

And here is something odd from my cpap data last night.  The pace of my breathing seems to have changed rather dramatically and suddenly.  Is there any significance to that? 

   

Thank you!

[Rubicon]

By the way, what is the significance of the PR events and in what way, if any, are they related to sleep apnea?


...The pace of my breathing seems to have changed rather dramatically and suddenly.  Is there any significance to that? 

Respiratory events can cause of number of immediate responses, including desaturations, cortical arousals and heart rate variability.  The 2 main foci of worry are the desaturations and cortical arousals.  Since there is no EEG, we (you, actually) might search for a surrogate-- in this case, changes in heart rate.  If we were really slick we could hook up EEG and adjust the criteria to correlate with PR event (right now it's 6) to match up with cortical arousals and have a pretty good machine to monitor sleep continuity.

But alas, we do not...

Anyway, with your suddenly improved sleep continuity (although that's only a 10 minute block) your PR events have dropped by 2/3s.

A coincidence?

I think not...

[Geer1]

Good, after you mentioned waking up numerous times in the night I was hoping the sleep study would have EEG data. The polysomnogram will be able to more accurately diagnose breathing (by ignoring "events" when you are awake) and will check other things like spontaneous arousals and movement.

PR events as stated on the report are a change of > 6 heart rate for more than 8 seconds. Since it is a measurement of change in heart rate it is not specific to breathing issues and it can be elevated for multiple reasons.

Since it is affected by so many things you can draw limited conclusions from it. I don't even know what a normal range is considered but I assume it changes with age like spontaneous arousals do. All you can really draw from this data is that you do have fluctuations in heart rate and that like the desaturations they appear to have improved when using CPAP indicating it is helping.

[Rubicon]

And here is something odd from my cpap data last night.  The pace of my breathing seems to have changed rather dramatically and suddenly.  Is there any significance to that? 

If the two examples you have presented thus far are representative, I wouldn't call that dramatic or sudden.

I'd call that miraculous.

But at most we're only looking at 2% of the night so shouldn't draw any hasty conclusions.

That said, using our surrogate IMO you're 66% improved so something happened.

Treatment-emergent apnea will improve if you simply leave it alone.  That might be one explanation.