Why is oxen saturation given more attention than sleep disturbances?

[NoddingHacker]

I met with some of the most "distinguished" sleep doctors in my country. They all dismissed the severity of my sleep apnea because my AHI was low, but even when my AHI reached 20 (I was heavier) they still said my apnea is not that bad because my blood oxygen saturation never reached low levels.

Now while having to operate on less oxygen than normal doesn't seem good to anyone, I thought the REAL damage of sleep apnea was the disturbance in sleep. Sleep cycles need to run their course uninterrupted if you want restful sleep. Nocturia (having to get up to urinate one or more times in the night) negatively affects sleep quality. One time or more in the entire night is enough to hurt sleep quality! So why in the world is sleep apnea considered 'severe' only at 30 AHI?

[staceyburke]

Oxygen desaturation effects all organs, heart, kidneys are extremely effected. Fragmented sleep will not do harm to important organs. One causes death the other quality of life.

Quote. When the kidneys receive insufficient oxygen, hypoxia (low blood oxygen) can occur, and chronic renal failure can follow. As this kidney disease progresses, the kidneys become increasingly full of fibrous tissue, and they cannot filter the blood or regulate salt properly. Like all organs, the kidneys need oxygen to perform well.

[Gideon]

First Aid 101!
ABC
Airway
Breathing
Circulation.

The first 2 of the 3 deal pretty directly with oxygen

[factor]

You have to have Oxygen to even live and sleep.   Sleep is not more important than oxygen.  Like Gideon said ABC is the most fundamental pathway.  Its like Air (oxygen), Water and Food.  Must have those.  Is it all related sure.  If your AHI is above 5 you still have OSA not as bad OSA as if it was 30 + but still OSA. Just because you loss weight doesn't mean you don't have OSA.

[cathyf]

Suffocation kills you fast, sleep disruption kills you slowly.

It's kind of like the difference between a heart attack and cancer -- but you're dead either way.

[archangle]

Personally, if my bedroom was saturated with oxen, I would give that a lot more attention than sleep disturbances. 

I'm pretty sure I wouldn't be sleeping anyway.

----

Unfortunately, a lot of medical "professionals" are pretty poorly educated.  They memorize a lot of things like the Latin names of the bones of the hand, and assembly line medical procedures. 

Oxygen desaturation is a bad thing, but that's not all there is to sleep apena. 

Think of it this way.   Every time you fall asleep, someone sneaks into your bedroom and chokes you until your sleeping brain starts to wake you up in a panic.  Your attacker detects you waking up and quickly hides and you never realize he was there.  You either fall back to sleep before becoming consciously awake or you just say, "darn, I'm not sleeping well tonight." 

You're going to suffer a lot of health damage from the poor sleep, the hormones, and the stress, even if your brain wakes you up before you O2 saturation drops.

[Broacher]

It isn't always everything. When I was admitted to ICU 3 months ago (2 in the morning, of course) my O2 sats were in the 90s, normal/low normal, but I was still having some difficulty breathing. (I was more concerned about my BP being in the 230 range!)

Then some tests and x-rays confirmed that I had a pulmonary edema. And then, three and a half litres of drug-induced pee later....

But the doctors told me that normally it was NOT the case for an edema to present with such healthy oxygen levels. They said that they had never seen that before.

Only thing I could think of was my singing. I've been an active chorus member for 25 years. I guess I have more lung capacity than I thought I had. But now I know what an edema feels and sounds like and I don't want to go through that again. That's why I asked to be tested for apnea and... well, here I am in 'severe' land. Tomorrow I pick up my first test kit. The adventure begins.

But yeah, ultimately it's the O2 that is the most immediate and direct threat to everything else. I mean, pretty hard to compare sleep 'disturbances' with oxygen level disturbances. 

(And if you have too many of the latter, you won't need to worry about comparing anything... ever again!)

[SarcasticDave94]

Most things Apnea make little sense to us, and apparently highly educated doctors are just baffled by it. If you want my advice, I'd get a nice shiny ResMed PAP, whatever mask suits, and PAP away. But if you really want any of this to make sense, then my sage advice changes a bit to simply don't hold your breath.

[archangle]

When I was admitted to ICU 3 months ago (2 in the morning, of course) my O2 sats were in the 90s, normal/low normal, but I was still having some difficulty breathing. (I was more concerned about my BP being in the 230 range!)

Unfortunately, the human body doesn't always follow the assembly line medicine paradigm.

One of the things that took a while too figure out when COVID started up was "happy hypoxia." 

The doctor or nurse would take an O2 saturation reading, see how low it was, and ask the patient "why aren't you already dead."  However, the patient would say they didn't feel any shortness of breath.

[mesenteria]

...

Now while having to operate on less oxygen than normal doesn't seem good to anyone, I thought the REAL damage of sleep apnea was the disturbance in sleep. Sleep cycles need to run their course uninterrupted if you want restful sleep. ... So why in the world is sleep apnea considered 'severe' only at 30 AHI?

No, the REAL damage of sleep apnea is that you get elevated levels of cortisol and organ damage as a result of chronic stress.  The sleep disturbances are deleterious in their own rights, but they are in addition to the more dangerous effects of desaturations.  The reason a great many people develop atrial fibrillation, as an example, is because the heart is repeatedly and dangerously stressed with signals to speed up while one's blood saturation levels of O2 falls and falls.....again and again.  

Is it not possible that people have other conditions that lead to apnea...and the ancillary conditions?  Can a person have leg movements, nightmares, obesity, GERD, throat conditions, nocturia, and other disorders that lead to apnea due to disordered sleep?  Sure.  And apnea can lead to disordered sleep.  What came first, the chicken or the egg?  Think 'systems'. 

I don't know why the apparently arbitrary number of 30 is the industry and insurance benchmark for severe OSA, but my guess is that they have looked at a raft of cases with various numbers and placed them on a standard normal curve.  Then, they took the first and second standard deviations, or something like that, and decided that if you're near what would be a second standard deviation, you're in the severe range.