New--Apnea vs Event?

[ginguro]

I've long suspected I have sleep apnea/hypopnea. Loud snoring, gasping, fatigue. My wife says I stop breathing when I sleep etc.--all the classic symptons. So my doctor sent me home with a pulse-oximeter for an overnight test.

My normal SPO2 is always in the 97-98% range, all day every day. My test results showed that my high SPO2 overnight was 97. Low was 82. Average 91.1.
I had 16 "events" lasting 3 minutes or longer--longest five minutes.
I had 17 "events" under 3 minutes with an average length of 75 seconds. Total time under 90% SPO2 during approximately 8 hours of sleep was about an hour and nine minutes. 33 "events" total so about 4 an hour. Heart rate went up concurrently with the events.

My question is, What is an "event"? Can't be an apnea I would think--no way I'm holding my breath 16 times a night for over 3 minutes. Hypopneas? Possibly both?

Took 4 weeks to get the results in the mail. Feb 26th to March 24th. Doc diagnosed me with hypoxemia, sent all his patients a letter saying he was going into semi-retirement because of all the new paperwork associated with the new ACA and went on vacation. We can go see his NP in the meantime, if an appointment becomes available.

Obviously I need a new primary care doc but in the meantime, how seriously should I take my "events"? I find it a bit unnerving. So far I've managed to wake up in the mornings. I've ordered a CMS 50Dplus and plan to track and print the results when and if we can find a new doc.

Any comments would be much appreciated.

Thanks, Ginguro

[trailrider]

Well, first thing is a sleep study. So depending on your health coverage and circumstances see the NP and ask for one (describing all the things you listed here and the O2 desats). Alternatively, get a home study done. Others here can walk you through that process better.

Sorry, I'm also confused because your profile lists a machine and a pressure. But in your posts the events you refer to are O2 desaturation picked up by the oximeter. I think a desat event can easily last 5 minutes due to the time lag from multiple apnea events in a short period. It is not unusual to have apnea event clusters. My data can frequently show 5 events occurring within 3 minutes, or even 1 minute. So what you are seeing is not unreasonable

[TyroneShoes]

Events for an oximeter may be different from events relating directly to SA. SA events can certainly lead to 02 desaturation, which may be flagged as an event by an oximeter (I am not knowledgeable about those). And that is exactly why SA events are something to be dealt with. An oximeter basically records a running record of your current 02 saturation. It may be configured to flag an "event" when the number falls to a certain percentage, such as 92%.

Trailrider is correct; the best move would be a PSG study, hopefully a split study with titration, to get an idea how helpful xPAP might be.

But, simplified, SA events fall generally into 3 categories (there are more sophisticated breakdowns and extensions for those who have issues beyond classic sleep apnea).

Hypopneas are breath cycles that measure as shallower than the surrounding breaths. Centrals are when your CNS fails to maintain the 02 feedback cycle that tells your body to breathe. Obstructive events are when the airway is obstructed or partially obstructed. These three are often lumped into a summary index called AHI, which boils down to the number of events per hour. They are also flagged by how long the event lasts. For instance, if a central lasts just a few seconds, it is not considered an event, and not significant to be of concern.

But this is just the tip of the iceberg. Having an AHI of 10, for instance, may mean that you have 10 events per hour on average that are all 10-15 seconds long, or 10 ten events per hour that are over a minute long. The second example will definitely desat you much more severely than the first example. And if you have high centrals and low OSA events, that is quite different than a lower amount of centrals and a high number of OSA events, even if the AHI for each example there works out to the same number.

So AHI is a simplified way of looking at things, and can mean a lot of different things unless parsed more specifically. It is valuable as a general rough measure of your condition or progress, but does not begin to tell the entire story.

You need a PSG to find out what the numbers will be untreated, and treated, before you can get a proper diagnosis.

Bottom line, SA events are events that can lead directly to desat, but they do not directly tell you how desatted you might be. An oximeter can tell you directly how desatted you might be, but does not tell you exactly why.

I would also be unnerved by this, and would feel that it is necessary to get to the bottom of what might be going on. Find a neurologist or pulmonologist with a background in sleep medicine, and start there. I would avoid an ENT (their practice is usually split too many ways, making them less expert in what you need) and also avoid a large sleep clinic, because they often are assembly lines for profiting from patients rather than being a useful tool for your sleep doc to give you the care you need.

[ginguro]

Thanks trailrider. The machine listed is the one I'd buy if the need arises after quite a lot of research. When registering for the board you need to answer all the questions, and rather than put "none" or "don't know" I entered that information. Sorry for the confusion.

Ginguro

[Sleeprider]

I'm pretty sure an "event" is a SpO2 desaturation less than 88. You definitely have an issue, and this preliminary result is probably prim-facia evidence of OSA. You might try to ask your doctor to simply prescribe auto titrating CPAP based on those results. That would save a ton of money and delays in sleep studies. It might work, and it depends on your insurance requirements. Considering that a sleep study can exceed the cost of a machine, it seems like a good risk to take. Try it.

The next logical step if we don't take the shortcut is a home study on APAP or clinical sleep study. Sounds like you already know where you need to be on this.

[ginguro]

Thanks TyroneShoes and Sleeprider. I looked at the results and it does say 88% or lower for the events.

Had a sleep study quoted at $3700 at our local hospitals' sleep center. There's a local sleep lab that's cheaper, but they don't have a Dr. or any other specialists on site. Just a couple people who give the overnight tests. Guaranteed to sleep because they have your doc OK 10 mgs of Ambien. The lab looks to be a chain store operation with a sleep doctor at some far off location who gets e-mailed the results, then interprets them and makes a recommendation to your Primary Care Physician. Basically seems like a real expensive motel with a snore meter.

Maybe an Airsense10 Autoset and Sleepyhead software is a better alternative. Big deductibles make that the most attractive option right now anyhow.

Thanks so much,
Ginguro

[trish6hundred]

Hi ginguro,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you as you start your CPAP journey.

[truetopath]

I would definitely go with the step of just asking your doc to prescribe an auto cpap, and go from there. If he doesn't bite, I'd insist on a sleep study, just to make sure it's not complex apnea. As far as the lab with the ambien, you're pretty much guaranteed to walk out with a sleep apnea diagnosis because ambien can actually worsen apnea.

[Crimson Nape]

I don't know how your oximeter is setup but here are the default parameters off mine. My oximeter is programmable but is, by default, set at any SpO2 saturation change that is 4% or greater for a 10 second duration or drops below 88%. The default pulse rate parameters are, any change at or greater than 6 bpm for an 8 second duration or longer. These are recorded as an event and don't reflect an apnea. The act of getting up during the night can cause a quick SpO2 drop. So can accidentally bumping the finger probe. The will show as spikes(outliers) in the graph which a reviewer would know to discard but will still be recorded ad an event.

I hope this may help.