[Diagnosis] Home Sleep Study Results & Feedback

[togapilot]

Good evening! 

I'm new to the board. I have found the wealth of knowledge available in the forums and the feedback provided by its members to be impressive. I just completed a Home Sleep Study (Type II) and am I'm looking for some feedback/opinions/recommendations with the understanding that advice provided here should not be construed as medical advice. The sleep study interpretation is that of mild sleep apnea primarily characterized by hypopneas with mixes of obstructive/central features with what I am told are significant desaturations given the relatively low AHI. I anticipated the diagnosis and was hoping that an oral appliance might be an option for me. I won't go into detail unless relevant but an attempt at using CPAP years ago was unsuccessful. I am being told that an oral appliance would not be effective given the prevalence of central apneas as well as the desaturations. An ASV device was recommended and I can tell from reading through the forums that this might be the best route? Maybe I am wrong here but it appears to me that the majority of the hypopnea events are obstructive in nature? If so, it would seem that a reduction in the Obstructive events (possibly an oral appliance) would result in a much lower, or even "normal", AHI.

I just had a consultation this week and am considering my options. It is my nature to try and dive into reports such as this, to understand them as much as possible and to take an active role in my health - just looking for general feedback and comments on the study and the therapy recommendation from the group - I know this isn't medical advice but I believe the first hand experience that many members here have is invaluable in situations such as this one. I've attached a redacted copy of the study (Sorry for the individual images - not enough posts to upload a pdf) and have inserted some relevant values below for quick reference. 

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• AHI: 8.3
  
• CA:  3
  
• OA:  1
  
• MA:  1
  
• OH:  56
  
• Average SpO2: 92.5%
  
• Desaturation Index:  7.5 per hour
  

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Thanks to all in advance for reading and for input and refer to the second post for the graphs from my study!

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2nd post from OP which includes the last two pages of the sleep study (3 attachment limit for the new guys).

Thanks again!

[vsheline]

… Maybe I am wrong here but it appears to me that the majority of the hypopnea events are obstructive in nature? If so, it would seem that a reduction in the Obstructive events (possibly an oral appliance) would result in a much lower, or even "normal", AHI.

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• AHI: 8.3
  
• CA:  3
  
• OA:  1
  
• MA:  1
  
• OH:  56
  
• Average SpO2: 92.5%
  
• Desaturation Index:  7.5 per hour
  

Hi togapilot
Welcome to Apnea Board!

You are knowledgeable and engaged and I am sure you will persevere until you achieve your goal for better sleep. 

I suspect a dental appliance (DA) might work adequately for you. At the same time, a DA might be quite expensive and often are inadequate except for very mild cases. Sounds like your therapists are indicating low confidence that a DA would do the trick for you, since you have quite significant desaturations. Nonetheless, may be worth a try, especially in view of your earlier lack of success using CPAP.

Looks like your Central Apnea Index (CAI) is less than 1 per hour. Sometimes medical insurance companies will refuse to provide coverage for an ASV machine unless the CAI is at least 5.  Other companies may go along with whatever the doctor prescribes.

Often APAP or BiPAP therapy will worsen CAI, forcing an upgrading to an ASV class machine which can treat both obstructive and central apneas.  That even with no pressure you are already susceptible to Central Apneas, this increases the likelihood that an ASV machine will be needed. 

By the way, I think ResMed machines have a smoother inhale/exhale pressure curve, which many find easier to tolerate than other brands. 

Also, mask technologies have progressed a long way in recent years, which you may find very helpful compared to your earlier experience with PAP therapy. Gosh, these days there are lots of varieties to try out.

If the cost is not a barrier, a dental appliance may be worth a try first. But if you can only go for one or the other, it sounds like in your case therapy with an ASV machine may be more likely to find success. 

Take care,
— Vaughn

[togapilot]

Resurrecting my original thread from about one year ago in hopes of getting some advice on Aircurve 10 ASV settings. I recently purchased this machine and hope to get some guidance on initial settings, along with the use of OSCAR, with the end goal being to get this machine dialed in to suite my specific needs. My original post included the results of an at-home Type II sleep study. I am also posting my initial sleep study results and INCOMPLETE titration from years ago in the event that it will help the experts in the group provide more meaningful feedback. I'm familiar with the clinician's interface on the ASV and how to adjust the settings. I also have a general understanding of how the ASV machine operates in that the EPAP range and PS range will determine the IPAP values (EPAP + PS). I also gather that I should probably start out in auto ASV mode with ramp off. Beyond that, I really don't know where I should start on pressures and hope to get as far ahead of the curve as possible utilizing feedback from the group. I did use the machine for a couple of hours last night and noticed the increased pressure and "blowback" technique that many speak of. I understand that Sleeprider and SarcasticDave are often referenced as the experts on ASV and hope that you guys can chime in but am ultimately interested in feedback from any group members that can help me establish some initial settings to get started.

Equally interested in feedback on the desaturations reported in the at-home study.

I'm certainly interested in the possibility of an oral appliance as vsheline suggested but I decided to dive in with the ASV machine to see how things go and to gather some data through OSCAR to gain some insight into my day-to-day AHI values, specific needs as well as how things like positional therapy might improve my sleep in the event that I'm unable to tolerate the use of CPAP as was the case almost twenty years ago.  

As a reminder, my most recent in-home study results are posted in my original post. My initial sleep study results from YEARS ago, along with an INCOMPLETE titration study are included in this post. AHI from the initial study was 11 with the more recent at-home study showing 8.3. As I understand it, an at-home study may have a tendency to under-report but it is worth noting that the two studies are close?

Thanks again to everyone who takes the time to review my post!

[Sleeprider]

If you're going to dive into ASV, we normally start with default settings in ASVauto mode at EPAP min 4.0, EPAP max 15.0, PS min 3.0 and PS max 15.0. In your case with very mild mixed sleep apnea with primarily hypopnea, and no PAP experience, I'm going to suggest some settings we use for individuals that don't have central sleep apnea, and mainly spontaneous respiration like yourself. We can learn from these low settings and adjust if needed. The low settings are EPAP min 4.0, EPAP max 8.0, PS min 3.0 PS max 8.0. That gives you a low-pressure bilevel therapy with ASV prompts to keep the hypopnea and centrals in check.

Your paperwork suggests bradycardia, and any help we may give here assumes you are in good cardiac health and no indications of heart failure which has risks associated with ASV. If you have questions about your cardiac health, I encourage you to get that checked out before beginning therapy.

[togapilot]

Thank you for the feedback on this Sleeprider! I started using this machine less than one week ago with an average of about 2.5 hrs per night primarily (I think) because of too much pressure during exhalation. Changed the settings last night based upon your recommendation and got over 7 hrs of use even though I felt like it was light sleep at best. I'll give it a few more nights before I share some OSCAR data with the group to see where I might need to go from here.

Thank again! 

[Sleeprider]

Sounds like it is working out well. If you see UA events, those are obstructive and raising EPAP min is appropriate if those are happening at low EPAP pressure.

[togapilot]

OSCAR graph attached. It doesn't appear that I have any UA events, at least not at this juncture, but I probably need to work on mask leaks. Thought I would go ahead and post this up in the event that there is something glaringly obvious that I'm doing wrong.