[Diagnosis] nocturnal hypoxemia with hypoventilation, Moderate OSA

[vgrando]

Hi, I am not on 02 currently. I just completed a cardiopulmonary exercise test. During it, the Pulminolgy Residence said that they did not conduct it correctly. But I cannot remember what was not done. He was very surprised that the APAP included my Tidel Volume and Minute Vent!

[Jay51]

My apologies for getting mixed up about supplemental oxygen at night.  That is strange:  test conducted but not done correctly (as reported by the Pulmonology Resident).  

Great job of at least mentioning, "tidal volume and minute ventilation."  By mentioning these terms again and again (and even spontaneous respiratory rate) your Dr.'s will hopefully soon see your #'s in these 3 categories vs. normal #'s.  A 4th important word to keep mentioning is "hypoventilation".  Quote your Co2 numbers to the Dr.'s from tangible tests.  

Great job Victoria.

[vgrando]

You did not make a mistake, I was on 02 until the titration study when my sleep MD took me off 02 without giving me any reason. I questioned him why he was not doing a home study of my 02, he just said did not want to do that. When he ordered this he had not seen any of my APAP data, and was just going with the titration study. He never said it was not done correctly or that it showed I still had issues as the Pulmonologist Resident just told me about. 

I felt that I had to comply because he does not want me to adjust my settings and when I told him I was having mostly CA for weeks, his response was that I had no CA during the titration study, which is interesting. I seem to have more CA when I awaken during the night, but my tidal volume is lowest when I am asleep. I just checked my sleep data for the night of the Titration study, and I didn't wake up. 

I am so concerned because he seems to be ignoring my diagnosis of hypoventilation and hypoxemia, which were left off of the titration study diagnoses. Yes, on my APAP do not desaturate all night, but I still desaturate. Last night I dropped to 83 with a heart rate of 120 for a short time, I was below 90% for 28 minutes and my 02 score was 6.0

Can you explain the 02 scores to me?  thank you!

[Jay51]

Thank you for clarifying all of that.  The drops in o2 at night are most likely from the CA's I would think. Other things could be causing them, too - the lung issue that you have, etc.  "I was below 90% for 28 minutes and my 02 score was 6.0"  As per Medicare guidelines, 5 minutes or more below 88% oxygen saturation during sleep qualifies for supplemental oxygen.  You are most likely below this much longer that the required time constituted by Medicare. Show him this specific post you just posted here.  

It is probably going to take tangible data like this to convince him and make him change his mind.  I am sorry that some important results were left off of your sleep study summary.  You can keep showing him that data and your new o2 data at night and even some OSCAR data that shows the CA's.  Tell him how you feel about that and how you feel after an average night's sleep.  

A lot of people arrive here at ApneaBoard because of errors made in their treatment.  It took a lot of patience, hard data, and explaning to get the results I needed.  


I went through a  similar process, and I will do my best to help coach and support you until you get the desired results (better respiration statistics - tidal volume, respiratory rate, minute vent), and O2 readings at night.  Others may also want to post if they see something that could help your case.