Help Needed re Apnea Test Results

[Dreams of Green]

Hello, my wife was recently diagnosed with apnea. She used an in home test kit and it rated her at mild, 13 AHI. I think all results are entirely automatic.

However I'm exceptionally suspicious about the results and deeply concerned that the pulmonologist seems to think it's no big deal, and is telling her she only needs to use CPAP for a week before and after surgery! Now if she really did have mile apnea I might be OK with that. 

But she had 8 events where she went under 85% oxygen saturation with her lowest being 72%! I am not an expert, but correct if I am wrong that you have to be in an alternate universe for that to be mild apnea.

She also had 87 hypopneas, which they don't appear to count as relevant. I hear my wide stop breathing and gasping for air all night long. I'm just blown away this test could come back as mild, and even more blown away the pulmonologist is convincing her it is no big deal, which is exactly what she wants to believe.

[DeepBreathing]

AHI is a pretty crude measure of the severity of apnea. As somebody said in another thread recently, using AHI categorised as mild, moderate and severe was originally devised by researchers doing statistical analyses. The AHI tells how many times a patient has interrupted breathing apnea and hypopnea) per hour on average over the night. It doesn't measure how long each individual event lasted: a 10 second event scores the same as a sixty second one. It also doesn't measure how events are clustered - a sequence of 15 sixty second events will score the same as 15 individual 10 second events over a whole night.

This sounds to me like a case for a proper in-facility PSG test, where a properly trained and observant technician (assuming you get one) will observe all the factors affecting sleep, not just a raw score AHI.

[mesenteria]

D o G, you are quite correct to be worried, and you shouldn't let this slide IMO.  Even mild apnea puts a repeated strain on the heart by making it pound trying to get more oxygen to the brain when desats happen below 85%.  The heart is meant to have an easier time while the body is limp during sleep.

As DeepBreathing says, AHI is a crude count of events.  It tells us nothing qualitative or quantitative unless you can also measure oxygen levels, heartrate, BP, and brain activity.  If one is constantly being aroused in an effort to breathe, one doesn't get to the highly necessary REM cycles.  And further, DB mentioned the phenomenon of 'clusters' of events which hints strongly at chin-tucking towards the chest.  Hypopneas and obstructive apneas can be greatly reduced if a person learns to keep his chin up, or uses a soft foam cervical collar to help keep it up while sleeping.

It would really help if you can post some graphic data using OSCAR (see it in the black marquee running atop the page) as soon as it is possible.  We'll have a better idea what we're dealing with.

[Sleeprider]

AHI is the sum of apnea (central and obstructive) and hypopnea, divided by the number of hours of the test. The AI is the apnea index and counts only apnea events. An additional index also scores respiratory event related arousals (RERA). All are relevant to sleep disordered breathing and health. If your wife had 87 apnea over an 8-hour sleep session (10.9) then her AI (13) + HI (10.9) is 23.9 in the moderate range and clearly requires treatment.

This should be sufficient for a prescription of Auto CPAP which she can use to self-titrate, or for a further sleep study to evaluate CPAP titration. You are now familiar with how competent the medical community is with sleep disordered breathing, and won't be surprised my recommendation is to take the prescription and obtain an auto CPAP (specifically a Resmed Airsense 10 Autoset For Her) from an in-network DME if you have good insurance, or purchase outright at about $650-$750 from online suppliers.

You will find it much faster, and you will end up with better results if you just use the prescription to obtain the Autoset, and use the Apnea Board forum for support and optimization.

[Gideon]

  What he said.

[DeepBreathing]

AHI is the sum of apnea (central and obstructive) and hypopnea, divided by the number of hours of the test. The AI is the apnea index and counts only apnea events. An additional index also scores respiratory event related arousals (RERA). All are relevant to sleep disordered breathing and health. If your wife had 87 apnea over an 8-hour sleep session (10.9) then her AI (13) + HI (10.9) is 23.9 in the moderate range and clearly requires treatment.

The OP stated: "She used an in home test kit and it rated her at mild, 13 AHI ... She also had 87 hypopneas, which they don't appear to count as relevant".

Unless the OP has misunderstood the report, the hypopneas would have been included in the calculation of the AHI, which was 13. I don't think a packaged test would give you the AI and not give a rating for hypopneas - the standard parameter I'd expect to see is AHI. This would further explain why the doc wasn't concerned, and why the apnea was characterised as mild. I don't see anything to justify an AHI of 23. Neither do I see anything to say the lady had 87 apneas.

Perhaps Dreams of Green could confirm what the report actually said, or better yet, post a copy of the report. Otherwise we're just guessing.

[Dreams of Green]

Hello Everyone,

Thank you so much. First off, the good news. The pulmonologist did NOT tell my wife she only had to wear it for two weeks, that was a misunderstanding on her part from some of the communications back and forth with the doctors offices. What he wants is for her to wear it for 2 weeks and then bring the SD card in so he can evaluate the results and recommend new settings for the Autoset machine as needed.

I was indeed wrong about the hypopneas, they are included in the result of 13 AHI.

I do strongly suspect that an in-lab sleep test would have shown much more severe apnea.  There are times at night where literally all I can hear is one apnea after another. It may not be technically so, but what I mean by that is I will hear her breathing passage slowly closing, and a choking sound as her breathing gets more and more shallow. Then as some point I am it stops altogether, which I assume is at the point her breathing passage has pretty much closed. Then her brain wakes her, I hear a huge gasp, and then the process starts all over again until she does the same thing a few minutes later.

I suppose it is possible it's only 13 AHI, but what scares me when I am listening is the severity of what I hear, not the frequency of occurrence.

At some point in the future I'd like to both go in for in-lab tests just as a follow-up. She seems to be coming around and is committed to wearing it, that is the important thing.

[DeepBreathing]

The good thing is that if she has an Autoset then the initial diagnosis is (to some extent) irrelevant. The machine will, when set up properly, adjust pressures as required to combat both apneas and hypopneas. The thing now is to work with her doctor to optimise the therapy or - failing that - to work with people on the forum who will be able to advise.

[mesenteria]

...  There are times at night where literally all I can hear is one apnea after another. It may not be technically so, but what I mean by that is I will hear her breathing passage slowly closing, and a choking sound as her breathing gets more and more shallow. Then as some point I am it stops altogether, which I assume is at the point her breathing passage has pretty much closed. Then her brain wakes her, I hear a huge gasp, and then the process starts all over again until she does the same thing a few minutes later.

...

I offer this about what I have left in your quoted text:

My wife has precisely the same experience, and it's highly deleterious for both of you...for what surely are obvious reasons. I convinced her to start wearing a soft foam cervical collar.  She hated it, still hates it...…...…………...……...but......she wears it for my sake if not hers.  Very happily, she sleeps so much better with much less apnea.  While you and your dear wife are trying to get her sorted out with PAP treatment, it might be something to keep in your back pocket.  If it turns out that she breathes through her mouth, or leaks through her mouth once her PAP therapy is finalized, the collar will help that as well by keeping her chin up.  Again, something to have in your back pocket.

[ragtopcircus]

If I am reading between the lines correctly, your wife initially heard what she wanted to hear. That happened a lot with my wife’s oncologist.

The SD card data will tell the tale.

In all fairness, I racked up plenty of denial miles for apnea myself.