My husband just had his oximetry done and we got the results. On the report the recommendation was for a split study if patient meets criteria--and then it goes on to say that patient should be initiated on oxygen supplementation in sleep at 2 LPM until study is complete. the dr. didn't say anything about this and we are wondering if it is necessary or would help. I did place a call to the dr. today about this--mostly out of curiosity. would this be a big deal or not. The findings were severe degree of sleep disordered breathing. with Baseline sat. 92%; lowest Sp02 was 63%; Desat index 58.4; time spent with oxygen saturation less than 90% was 56.3%; Less than 85% was 15.2%.
Are we making a bigger deal out of this than it really is??
Thanks

Nope, its a big deal. At a baseline of 92%, I would guess that the physician would like to keep him in the mid to high 80's at the very lowest. (Ideally for a baseline of ~97%, the physicians that I work with like to keep the patient above 90%). It appears that your case may even be covered by insurance. Meeting the medicare guidelines for reimbursement on home oxygen is tough, but your case should meet that. Heck, I think patients have to be blue to be put on home oxygen.

Cpap may correct the hypoxemia, which is probably why the O2 is indicated until the study. It may not, but that is a road that they will cross when they come to it.

Just my opinion.

NO, you aren't making a big deal about nothing! His baseline 02 saturation is disturbing. It is adequate. BUT it is a RESTING, just sitting around, 02 saturation. What is it when he is up and about, walking up stairs, etc? If you are in the hospital and your 02 sats drop below 90% for very long or very often they start you on supplemental oxygen.

Half of the time your husband was sleeping his 02saturdation was less than 90%, it was 56.3%. NOT good! It isn't even how low his desats went so much as it is the AMOUNT OF TIME he was desaturated. 56.3% of the time.

I don't mean to scare you but, yes, you do have cause for concern. It is good that they are going to get him scheduled for the split night study soon. He needs that titration as soon as possible so they know his pressure needs and can get him started on xPAP therapy.

Has your husband had his daytime 02 levels checked? Arterial blood gases drawn? Pulmonary function test? Six minute walk w/oximeter? Spirometry? Does he have cardiopulmonary problems?


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Just to make a clarification--when he's up and around his 02 is up! to normal. he got up a couple of times during the night and it bounced right up there within normal limits
it's just when he's sleeping it goes down. we're also at a higher altitude as well about 4500 ft.--we live in Utah. I have heard that 02 levels (normal) are a little lower because the air is thinner. Also FYI--he is healthy otherwise age 44 and did have a cardio work up not too long ago because he was having chestpains which later we found out was just heartburn. (everything was normal on the work-up) his 02 only dips when sleeping.--that's why we think he has OSA

Well, THAT is GOOD to hear!!! Whew! Then yup, he's got some pretty severe OSA going on. Until his titration you might have him sleep in a recliner chair. That can help alleviate apneas to some extent.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

Well, THAT is GOOD to hear!!! Whew! Then yup, he's got some pretty severe OSA going on. Until his titration you might have him sleep in a recliner chair. That can help alleviate apneas to some extent.

that's what the dr. said about the chair--but back to the original question--should we be concerned about getting the 02 (for night) or is it a really big deal?? i'm not sure with the OSA it would help anyway?? but the report did reccommend it

I was put on 2L of supplemental 02 three months after starting CPAP therapy and was on it for 15 months when I was switched to a bi-level. They don't think I will need it w/the bi-level but my desats were no where near so bad as your husband's.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

I was put on 2L of supplemental 02 three months after starting CPAP therapy and was on it for 15 months when I was switched to a bi-level. They don't think I will need it w/the bi-level but my desats were no where near so bad as your husband's.

Im not trying to be a jerk, but what exactly is causing your OSA. Like you said in an earlier post, you do not appear to be a candidate (by your measurements), but you seem to have a moderate to severe case. Did you smoke for many years? If you do not want to post anything, feel free to PM me. Im always looking to get more information and you sound like an intriguing situation. Sorry if I stepped over any lines here, I certainly didnt mean to.

---

The original question:

When is your husbands titration scheduled for? If its been scheduled for 3-4 months out, then I would make sure you call to get on a waiting list. If a patient cancels, then can then call you guys to come down and basically fill their open slot. If you do that, then it probably wont hurt to wait a few days, but personally, I wouldnt wait too long. 68%, or whatever it was, is not something you want to mess around with. IMO, of course.

RAM, smoking has nothing to do w/OSA. OSA is caused by a narrowing and collapsing or blocking of the airway during sleep.

COPD, on the other hand, CAN be caused by smoking as well as other causes. Don't confuse the two.

I'm not offended by your question, no need to apologize. My sleep problems began after a whiplash in early 1994. I was Dx'd w/OSA in 1996 when I finally got desperate enough to push for an explanation of my exhaustion. I actually thought I might have Mono.

My problem for not getting adequate treatment until late 2006 tho was my own sheer bullheadedness and a tendency to cut my nose off to spite my face. I did start on CPAP therapy when first Dx'd but a mask cutting up my nose and a SHEISTER local DME supplier resulted in return of the equipment and 10 more years of lousy sleep. I do have a slightly deviated septum but prefer CPAP to surgery. I also have a head forward, shoulders rounded forward posture due to the whiplash. (Didn't have enough sense to allow them to transport me to ER and went untreated until 3 weeks after the fact - too late). So much for "toughing it out". The described posture encourages shallow breathing which can become a habit.

The supplemental 2L of 02 was AT NIGHT IN CONJUNCTION w/the CPAP therapy, RAM_Sleep, not during the day.

KaressaMom, it is a simple enough task to have your family doctor write a script for 02 supplmentation overnight whilst your husband is awaiting the titration study. Certainly any extra 02 can help w/his desaturations at night at least during hypopneas when some air is getting thru. But, no, it won't "cure" or even treat the overall problem of OSA. I was put on 2L of 02 overnight for 3 months because my OSA was rather mild and I was resistent to CPAP therapy given my earlier experience. Then another overnight oximetry still indicated possible OSA and I realized I had no option but to agree to CPAP titration and therapy. Two pressure changes and still problems and an overnight oximetry then indicated that I needed the 2L of 02 supplementation IN CONJUNCTION w/the CPAP therapy. But finally, switching me to a bi-level its been determined that w/a bi-level I don't need the supplemental 02.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

RAM, smoking has nothing to do w/OSA. OSA is caused by a narrowing and collapsing or blocking of the airway during sleep.

COPD, on the other hand, CAN be caused by smoking as well as other causes. Don't confuse the two.

I'm not offended by your question, no need to apologize. My sleep problems began after a whiplash in early 1994. I was Dx'd w/OSA in 1996 when I finally got desperate enough to push for an explanation of my exhaustion. I actually thought I might have Mono.

My problem for not getting adequate treatment until late 2006 tho was my own sheer bullheadedness and a tendency to cut my nose off to spite my face. I did start on CPAP therapy when first Dx'd but a mask cutting up my nose and a SHEISTER local DME supplier resulted in return of the equipment and 10 more years of lousy sleep. I do have a slightly deviated septum but prefer CPAP to surgery. I also have a head forward, shoulders rounded forward posture due to the whiplash. (Didn't have enough sense to allow them to transport me to ER and went untreated until 3 weeks after the fact - too late). So much for "toughing it out". The described posture encourages shallow breathing which can become a habit.

The supplemental 2L of 02 was AT NIGHT IN CONJUNCTION w/the CPAP therapy, RAM_Sleep, not during the day.

KaressaMom, it is a simple enough task to have your family doctor write a script for 02 supplmentation overnight whilst your husband is awaiting the titration study. Certainly any extra 02 can help w/his desaturations at night at least during hypopneas when some air is getting thru. But, no, it won't "cure" or even treat the overall problem of OSA. I was put on 2L of 02 overnight for 3 months because my OSA was rather mild and I was resistent to CPAP therapy given my earlier experience. Then another overnight oximetry still indicated possible OSA and I realized I had no option but to agree to CPAP titration and therapy. Two pressure changes and still problems and an overnight oximetry then indicated that I needed the 2L of 02 supplementation IN CONJUNCTION w/the CPAP therapy. But finally, switching me to a bi-level its been determined that w/a bi-level I don't need the supplemental 02.

I am not confusing the two. I am certainly capable of making mistakes, but im not mixing OSA and COPD. With that said, smoking seems to be a risk factor for OSA, at least according to current research. Just like any research, you are going to be able to find arguments for both sides of the coin.

- Higher Prevalence of Smoking in Patients Diagnosed as Having Obstructive Sleep Apnea

- Lifestyle factors also affect the likelihood of developing OSA. Cigarette smoking increases the risk, which appears to resolve with smoking cessation.

- Studies mostly conducted in the United States concluded that cigarette smoking is a predictor of obstructive sleep apnea and that it increases the severity of nocturnal oxygen desaturation

It isnt clear cut that it is a risk factor, but the general consensus is that it isnt helping sleep issues. There is a large study due out early 2009 that is going to provide all of us a ton of information.

Thanks again, RAM_Sleep. One thought that crossed my mind after I posted was that there is evidence that smoking does tend to decrease muscle tone over time.

I doubt that smoking HELPS much of anything. Altho it is said to be somewhat "beneficial" to Ulcerative Colitis patients and detrimental to Crohn's patients (two forms of Inflammatory Bowel Disease). Even if it weren't for all the "tars" etc. caused by burning materials of any kind, one would think that just the HOT air being sucked into the lungs w/every puff would be detrimental to delicate lung tissue.

Are you w/in the medical profession by any chance, RAM_Sleep?


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

Thanks again, RAM_Sleep. One thought that crossed my mind after I posted was that there is evidence that smoking does tend to decrease muscle tone over time.

I doubt that smoking HELPS much of anything. Altho it is said to be somewhat "beneficial" to Ulcerative Colitis patients and detrimental to Crohn's patients (two forms of Inflammatory Bowel Disease). Even if it weren't for all the "tars" etc. caused by burning materials of any kind, one would think that just the HOT air being sucked into the lungs w/every puff would be detrimental to delicate lung tissue.

Are you w/in the medical profession by any chance, RAM_Sleep?

Im a registered sleep tech and respiratory therapist (RRT). I do all of the preliminary reading of sleep studies at the facility that I work at. Not sure how much of that you wanted to know.

You?

oops got posted twice



Last edited by karessamom on Wed Jul 02, 2008 9:36 am; edited 1 time in total

ok guy's didn't mean to start a battle here LOL    FYI he has NEVER smoked in his life (neither one of us do and we avoid 2nd hand as much as possible--he also was never exposed to it as a child)--he is overweight(BMI 37.3) and has a large neck--18, he also has asthma but that rarely bothers him anymore. and allergies for which are pretty much controlled. We also don't drink-- i might add that he has heartburn which is taking prylosec for but has flare-ups at night of coughing up acid. not sure if it's the OSA causing it or the heartburn that's causing the OSA--read both ways. his 1st full sleep study will be this Saturday on the 5th and will return to dr. on the 28th for results (don't know if they'll schedule a tritration in before that or after the 28th. (the report reccommended a split study but dr. said baseline so i don't know).--this gives the lab a couple of weeks to get the results back to the dr.  
as a side note--i do so much appreciate all this good advice and answers that you've given. It helps--i have learned so much! thank you

karessamom wrote:

ok guy's didn't mean to start a battle here LOL    FYI he has NEVER smoked in his life (neither one of us do and we avoid 2nd hand as much as possible--he also was never exposed to it as a child)--he is overweight(BMI 37.3) and has a large neck--18, he also has asthma but that rarely bothers him anymore. and allergies for which are pretty much controlled. We also don't drink-- i might add that he has heartburn which is taking prylosec for but has flare-ups at night of coughing up acid. not sure if it's the OSA causing it or the heartburn that's causing the OSA--read both ways. his 1st full sleep study will be this Saturday on the 5th and will return to dr. on the 28th for results (don't know if they'll schedule a tritration in before that or after the 28th. (the report reccommended a split study but dr. said baseline so i don't know).--this gives the lab a couple of weeks to get the results back to the dr.  
as a side note--i do so much appreciate all this good advice and answers that you've given. It helps--i have learned so much! thank you

No battle here.

I wouldn't bother with the O2 then. If he has a study in a few days, then the O2 is unnecessary. IF the Cpap/BiPap boosts his oxygen levels into normal range, then he will be set. I look forward to hearing about his incredible improvement!

They will split the study, as long as the criteria is met and he is not suffering from central sleep apnea. Some labs will not split those studies.

Good luck!