I finally got my husbands sleep study report!  (actually it came rather quickly) I've added my own comments in ()
The results as follows--Baseline sleep study indicates severe degree OSA (not surprising) associated with severe desaturations during REM sleep. Total AHI 120/hr. AHI during REM sleep 94.7/hr. with lowest saturation 67%. Avg. sat. 90%. EEG arousals were frequent that contributes to fatigue (no wonder he's miserable) it says a few other remarks on the conclusions--
He only had 1 central apnea and 3 obstructive hypopneas. I have a figure for RDI which is basically the same as the AHI--Does RDI stand for Respiratory Desaturation Index?? (I'm thinking) anyway in REM it was 94.7; NREM 122.9; TST#/h (sleep) 120.0

How bad is this reallly?

we hope to hear something in the next few days about where to proceed from here. apparently dr. isn't a big fan of titration studies and just usually orders an autoset machine. We'll see what happens. then what do we do???
Thanks

karessamom wrote:

I have a figure for RDI which is basically the same as the AHI--Does RDI stand for Respiratory Desaturation Index?? (I'm thinking) anyway in REM it was 94.7; NREM 122.9; TST#/h (sleep) 120.0

How bad is this reallly?

RDI is Respiratory Disturbance Index and is not the same as the AHI. It is apneas + hypopneas + RERAs per hour of sleep. If no RERAs exist, then then the value may be the same as the AHI.

REM 95 / NREM 123 is severe.

Why didnt they split the study and titrate him?

RAM said: "Why didnt they split the study and titrate him?"

I don't know other than the baseline is what dr. ordered. they couldn't do anything else. The tech we talked to had told us in the past he's seen many patients struggling but can't do anything if it's not ordered by the referring dr.

karessamom wrote:

RAM said: "Why didnt they split the study and titrate him?"

I don't know other than the baseline is what dr. ordered. they couldn't do anything else. The tech we talked to had told us in the past he's seen many patients struggling but can't do anything if it's not ordered by the referring dr.

As a tech, I have felt bad for those who I have watched pause time and time again, but on the other hand its a "normal" nights sleep for them.

Im torn regarding split night studies, however insurance companies are not. If that lab seriously has a policy to neglect split night studies, then the participating insurance companies are going to be ringing their phones off of the hook. I cant disagree from their point of view. A lab is taking advantage of the system by only ordering baseline studies, if that's what they are doing.

On the other hand, split night studies can be worthless. Some techs only want overall numbers, so they will do what it takes to get low AHIs. That may involve vigorously increasing pressure until the "real" events subside, but now CPAP induced centrals present and the patient suffers a load of onset events, which are not score-able. Dont confuse this with Complex OSA. Im talking something all together different.

At least a full night titration will give the techs ample time to get him properly treated. It just sucks because split nights are standard, require a revisit, and a delay the treatment.

I'm on both sides of this fence, depending on the tech that is working for the patient...

I think the problem was the insurance to begin with. I think the reason the dr. ordered the baseline was because the insurance wouldn't pay for the split or titration part of it until the baseline was done. (it's not the lab that ignored the split study--it was reccomened in the oximetry report that he had a split done) That's why we had to go with the simple oximetry first even though the dr. was pretty sure he had SA. He had to be screened with the oximetry test, then step up to the baseline etc. They actually aren't even doing a titration study at least at this point and we're in the process of getting an autoset.

The main problem I see w/at-home auto titrations in place of a baseline in-lab titration study is when there were other sleep disorders present at the in-lab evaluation. W/o an in-lab titration you really have no idea if xPAP therapy reduced or eliminated them or not. Some do respond to xPAP therapy in that they were caused by the underlying OSA. But not all and not always.

On the other hand, at-home auto titration studies can usually be set up much more quickly than scheduling an in-lab titration study. And a serious draw-back to in-home auto titration studies for first-time xPAP users is the mask adjustment and the pressure adjustsments whereas an in-home auto titration study for an experienced xPAP user makes much more sense than an in-lab titration in most cases.

At least to my way of thinking. What do I know? I'm just a layman xPAP user!


_________________
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.

I have never heard of a lab using a home oximetry test as the baseline. I HAVE heard of labs using it to screen for baseline tests, which is what karasmom went through.

However, all of the physicians at our lab order baseline tests, but if they meet criteria, then we split them. It happens the majority of the time. I guess if the physician specifically ordered a baseline, then we would go through that, but currently we only refuse to split CSA patients along with children under 16.

*Obviously, we do not split patients that do not meet the criteria*

Ordering a pure baseline test is a complete waste. Look at your insurance company:

1) Pay for home oximetry (~ 400 dollars?)
2) Pay for baseline (~ 2100)
3) Pay for titration (~2300)

ALL of this could have been accomplished with a single split night study (~ 2300)

Its a real shame that stuff like that happens.

Oh well, its not a perfect world and I certainly do not feel bad for insurance companies, but I think that they CAN be taken advantage of...

RAM_Sleep wrote:

I have never heard of a lab using a home oximetry test as the baseline. I HAVE heard of labs using it to screen for baseline tests, which is what karasmom went through.

However, all of the physicians at our lab order baseline tests, but if they meet criteria, then we split them. It happens the majority of the time. I guess if the physician specifically ordered a baseline, then we would go through that, but currently we only refuse to split CSA patients along with children under 16.

*Obviously, we do not split patients that do not meet the criteria*

Ordering a pure baseline test is a complete waste. Look at your insurance company:

1) Pay for home oximetry (~ 400 dollars?)
2) Pay for baseline (~ 2100)
3) Pay for titration (~2300)


ALL of this could have been accomplished with a single split night study (~ 2300)

Its a real shame that stuff like that happens.

Oh well, its not a perfect world and I certainly do not feel bad for insurance companies, but I think that they CAN be taken advantage of...

Yeah it didn't make a lot of sense to me either! Hey I just go by what they tell us to do. who knows maybe he didn't meet the criteria?? or maybe it's different in utah. I do know that the tech said that right now, they aren't allowed to do much but when some laws change--they will be allowed to do more.
I guess that's why they're not doing a titration study and want to go directly to an autoset machine.  What's weird is they are trying to save $$ but by the time they do all the "stepup" testing they could have done the 1 test for less in the long run!  

Well, in my case, a split night study IF I had qualified in those first few hours of sleep, would have had to result in a second night of titration only. As it was I had to go back for two titrations because I only slept 42 minutes out of 6 hours bedtime the first and even at the second titration only slept 98 minutes out of six hours bed time. *sigh* I seem to have a knack for doing things the hard way.

And even when we did end up doing an at-home auto titration it was darn near a disaster, thanks to the sheister DME I had. I'm already on CPAP, WITH an integrated heated humidifier, that THEY provided so they were well aware of the brand and model. The loaner auto PAP they gave me was a different brand and I was told they had NO HUMIDIFIER of any kind available. Two nights w/it and I had to skip two nights to heal my nasal passages, they were raw. My sleep lab manager managed to dig up a passover humidifier but two nights of THAT put me back in the same boat. Raw nasal passages and two more nights w/o xPAP. FORTUNATELY, a fellow CPAPper read of my plight and EXPRESS MAILED his extra F&P HC 100 stand alone heated humidifier which saved the day. (Well, nights).

The ONE satisfaction I got was that the sheister DME could NOT charge rental for the loaner PLUS rental for my CPAP as my CPAP developed a problem just before the loaner was ordered and altho it took a call to the manufacturer to get the sheister DME to admit there was a problem and replace it they had no choice and couldn't double-bill my insurance. GLOAT!


_________________
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.