Opinion on Sleep Study

[SarcasticDave94]

Geer1 has a very good point about stopping the quest for another study. In my search for a doctor that would issue a machine above ASV due to Respiratory Disease and Central Apnea, doctor and sleep study tech at UPMC Hanover, PA butchered the diagnostic and Titration results, disqualifying the need for Central Apnea support. While the test was inaccurate, it required a new test at another new doctor to show the prior was wrong, to prove that CA still needs treated.

So you should stop, think what your goal is, and do you really want to continue tests if you're already getting some treatment. Define very specifically, what are your goals with continued tests? Do you need to go to a different level of PAP therapy? What specific outcome are you after? What do you expect to gain or get with more testing? What PAP therapy benefit are you trying to get?

My earlier post said we'd need to see the medical opinion and analysis pages. This is the paragraphs of doctor opinions, where they state what the test showed, what diagnosis they state, what they are prescribing. Your current machine is a Philips Respironics DreamStation Auto CPAP.

[dataq1]

I should have made it plain that I am asking for a friend, who was not on any therapy, never thought they needed therapy, and since this sleep study and being placed on therapy (5-15) feels no change in sleepiness (Epworth still less than 6)…. Is questioning if the basis (sleep study above) should be questioned as it it’s reliability.

After 90 days on therapy ( average AHi of 1.5 ) at pressure average of 9 (driven by flow limitations) my reaction is to be skeptical of the original sleep study - hence my questioning and asking here for other opinions and opportunity to learn from other forum users.


I concentrated my discussion here on the original sleep study so to attempt to avoid injecting MY bias (that the therapy may not be justified)

[Geer1]

I think your friend has signs of sleep disordered breathing. That said not all SDB needs to be treated, AASM and most doctors recommendations are only bother treat mild apnea cases (5-15 AHI) if the patient is symptomatic.

If your friend didn't have symptoms (daytime tiredness, fatigue etc) without PAP then they aren't likely to see any improvement on it and since PAP is invasive it may cause more harm than good.

If your friend was and still is symptomatic than the flow limitations could still be the problem and adjustments to settings may help but we would have to see OSCAR reports to get an idea.

If the end goal is to figure out accuracy of report than going in for an in clinic sleep study would be more accurate than another home test and they could mix it into a split night test where they first check for apnea and then if present perform CPAP titration.

[dataq1]

My impression is that my friend was prescribed the "on-the-cheap" sleep study as a pre-surgical test for a non-respiratory aliment. (Much like one might get a routine chest X-ray prior to hospital admission- "it's just what we do")

I don't know for sure that the requirements for insurance coverage for a home study are different than the more (I imagine) expensive in-lab sleep study that would include EEG and EKG as well as EMG.

The home study was interpreted by a sleep Dr, who prescribed the APap therapy.  (BTW, this is all being done virtually - this doc has never examined his patient)

When the sleep Dr reviewed the treatment after 60+ days and was asked if the treatment was really necessary, his response was that the low AHI values (averaging less than 5) proved that the therapy was working and that continued use was needed.

The problem with his assessment was that you are not proving anything unless you know where you started - that's when a copy of the home study was requested. 

This sleep dr had not known about OSCAR, nor that we were getting OSCAR data. He only has access to the data that the DME sends him. 

When the home study report was obtained, skepticism really took root. 

And that is why i was asking about other opinions and possible suggestions to present to the GP (who started this ball rolling).

My cynical self keeps whispering to me that doctors and DMEs maybe taking advantage of a situation that is not well understood by their patients.

[Geer1]

Home sleep studies are not perfect but they are proven to be quite accurate for sleep disordered breathing as they capture 90% of what is needed for sleep disordered breathing analysis, the only thing they are missing is EEG data to know at what time the patient is awake and what time they are asleep. They are far cheaper than in clinic studies and therefore have been adopted as the first test and are usually followed by a CPAP trial. In clinic PSGs are usually only performed if a client has failed to see improvement or have signs/symptoms of a different sleep disorder for which EEG, EMG etc data is required to diagnose (such as restless leg syndrome, periodic limb movement or rem sleep behaviour disorder).

Everything appears to be by the book so far. The only thing unclear is why this is being looked into. What "non-respiratory ailment" is present that they considered testing for apnea and then trying CPAP? I can only assume heart related (congestive heart failure and/or atrial fibrillation)?

[dataq1]

Ok I’ll ask.

[dataq1]

 The only thing unclear is why this is being looked into. What "non-respiratory ailment" is present that they considered testing for apnea and then trying CPAP? I can only assume heart related (congestive heart failure and/or atrial fibrillation)?

As I mentioned earlier my friend was checked by a Cardiologist who gave a clean bill of health (no heart failure, no arrhythmias).

So I did ask about the "non-respiratory ailment" that was being addressed (that might require a sleep study pre-surgery) that required a sleep study ....... and the answer was:

Exploratory kidney surgery with the possibility of resection and/or excision of both kidneys.   


(is there a "gobsmacked" emoji ??)

[Geer1]

Still doesn't explain why. What symptoms/issues are present to warrant CPAP or exploratory kidney surgery? I have a really hard time figuring out how the two could possibly be related so your buddy is going to have to spell it out for us.

Neither CPAP or exploratory kidney surgery are things you do for fun, there must be reasons for considering both (if there is no reason then of course there will be no improvement because there is nothing that is believed to be wrong).

[dataq1]

Still doesn't explain why. What symptoms/issues are present to warrant CPAP or exploratory kidney surgery? I have a really hard time figuring out how the two could possibly be related so your buddy is going to have to spell it out for us.

Without probing further into something that is clearly not my business, she explains that has had tumors growing very slowly in both kidneys. 

As she understands it, the reason for the sleep study was to evaluate her chances of survival after having undergone the kidney surgery, that is why they wanted to test her for sleep apnea. 

(my own take on it is the doctor wanted to rule out the possibility that she would die from apnea before succumbing to kidney disease or dialysis failure; in other words the sleep study was precautionary)

Regardless, she said that she had no complaints about sleeping either before or after the sleep study.

[Geer1]

Sounds like she is dealing with multiple issues and that she may not understand all of the reasons behind doctor's choice to test and recommend CPAP use.

My opinion is trust her doctor is doing what is in her best interest since not enough details are known to prove otherwise. As I mentioned before imo the data does support a sleep disordered breathing issue and the only thing unclear to me is what the doctor is trying to treat by addressing them. Usually sleep studies and CPAP are used to address symptoms related to poor sleep quality. In some rarer cases I have seen it recommended to deal with heart issues (since SDB is known to cause and exacerbate heart issues) and extend lifespans in people with heart disease. I have never seen or heard of CPAP being used for kidney related stuff but upon a quick google I did find this study and perhaps there is something doctor is aware of that we aren't.

https://erj.ersjournals.com/content/50/suppl_61/OA3210

If she has no issues with sleep with CPAP then there is no reason to complain or question doctor imo. If anything I would just review her data in OSCAR to see if her treatment appears to be adequate.