Sleep lab studies -- does this data look odd/wrong??

[cathyf]

I have a long story, covered elsewhere, of how I had a sleep study in November which concluded that I did not have apnea (AHI=2, min SpO2=92%), followed by another sleep study in April showing an AHI of 18 and min SpO2=86%.

Ok, I got what I really needed out of the April study, which is a diagnosis and a prescription and insurance will pay for my treatment. But looking closely at the results, they just look weirdly wrong. Here's the two summaries side-by-side:

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In November, the way I would tell the story is "2 OAs, a Central, 9 hypopneas, 9 RERAs, 9 respiratory arousals, 33 spontaneous arousals. A little going on, but all is just a little and doesn't rise to the level of a sleep apnea diagnosis."

In April the story is "106 hypopneas, end of story." No apneas either kind, no RERAs. 106 respiratory arousals (one for each hypopnea, aparently) but just 16 spontaneous. I was on a chin-tucking-positional-palooza, and managed a 42 AHI in REM sleep on my back and 39 nREM AHI on my side. But it's not even an AHI because with no apneas it's an HI!

Is that really believable? I had 106 hypopneas but nothing else happened? No not-quite-an-event (shorter than 10 seconds, 50% reduction, etc.) caused an arousal, etc. All those hypopneas and not a single apnea?

When I look at my OSCAR data, I have probably 10 apneas for every hypopnea, which these studies are showing little to zero in the apnea department and the only kind of events I have are hypopneas. Is this because the cpap machine has a different definition of apnea vs hypopnea?

I'm also looking at the submitted bills at my insurance company web site. The hospital charged $3578 for just the sleep study, although the insurance took it down to "only" $2,186,87. (insurance paid $2,733.59 in November for the same charge. My husband calls it the "random bill reducer"!) The insurance hasn't finished processing it, but the sleep doctor submitted an additional separate bill for $2,975 for reading the April study. That is a LOT of money for something that looks pretty slipshod!

I can understand the different scales, but why would the second test show ONLY those hypopneas and nothing else?

[Sleeprider]

Sleep studies are inconsistent, overpriced and fail on many levels. We see people on this forum diagnosed with obstructive sleep apnea that clearly have central or complex apnea. It is incomprehensible why the insurance industry requires this expensive, and often erroneous testing that offers so little benefit when the modern PAP machines offer data that can be interpreted more accurately by hacks like me than any sleep study that is actually written by a computer program, and signed off on by a doctor to give it some magical credibility. If your question is, are your inconsistent results surprising, the answer is no; the surprise is they actually got it good-enough in two tries.

[SarcasticDave94]

I see it as a variable test results status. Given the technician that runs the test may also be the one writing the results up, it's always hit or miss. On my own diagnostic and titration this year, the doc just reads what the tech wrote and that's what he based action on. The process leaves a lot of places for flaws in interpretation, and tends to accentuate a highly variable situation.

[cathyf]

Sleep studies are inconsistent, overpriced and fail on many levels.  We see people on this forum diagnosed with obstructive sleep apnea that clearly have central or complex apnea.  It is incomprehensible why the insurance industry requires this expensive, and often erroneous testing that offers so little benefit when the modern PAP machines offer data that can be interpreted more accurately by hacks like me than any sleep study that is actually written by a computer program, and signed off on by a doctor to give it some magical credibility.  If your question is, are your inconsistent results surprising, the answer is no; the surprise is they actually got it good-enough in two tries.

Yeah, I'd do things different if I were in charge!

I've heard a little about how Kaiser does this, and if I understand correctly, what happens there is that they basically send the patient home with an apap wide open and then look at the data coming off the machine to decide what to do. I've also heard that they have patient education classes, too!

I started this adventure 7 years ago with an ApneaLink home test. I don't know how it works now, but then the ApneaLink was free here -- they sent it home each night with a different local patient, who would bring it back in the morning and then the person who ran the cardiac rehab center had the job of downloading the data and doing the report. Of course it was mighty clever in that they got paid $2100 for the sleep study that came out of the ApneaLink study -- don't have to do too many of those to pay for the ApneaLink!

If I was running things, patients suspected of having apnea would do the take-home test. If you "flunked" that test, then they would RENT you an APAP, including the pulse-ox that plugs into the machine, and have you wear a fitness band and other assorted useful tools. The APAP would be connected in some way back to the sleep center, and the sleep tech assisted by some good software (*cough* including a professional-grade version of OSCAR/sleepyhead *cough*) would monitor your data over a couple of weeks. They could make adjustments, maybe decide you need a different machine, and since it's a REAL rental, as opposed to just a scam to get the patient to pay two deductibles, it would be no big deal to try out different things. After they had decided they really knew what tools were needed to keep your apnea under control, you would buy what you needed long term, and they would follow up periodically to make sure everything was ok.

We have the model for how to do this sort of thing -- my little local hospital ran the ApneaLink out of their cardiac rehab center because the cardiac rehab process works kind of that way. I bet it would be cheaper, AND patients would get better care because the money would be spent much better.