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Smokey
Unread post  Post subject: Two sleep studies, different equipment, different results  |  Posted: Thu Mar 10, 2016 10:50 pm

Joined: Sun Nov 01, 2015 1:56 pm
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Location: San Francisco, CA
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I had a two night at-home sleep study last October. The device was the Watermark Ares. My RDI was 16, AHI was 4.7. The oxygen saturation nadir was 86.4%. The recommendation from the lab was an auto-CPAP with a range of 4-20. That has been working fine for the past few months. My events per hour have been between 0.5 and 2. The pressure level seems to be maxing out at about 8.5.

But, I have a new insurance company and they wanted sleep study that tested respiratory effort. The first test didn't. So I had another at-home study, this time only one night, it was with a Respironics Alice PDX. It has a chest strap and belly strap that measures effort. The report doesn't show an average RDI but it says that when I was on my back I had an RDI of 32 score, my AHI was 23.8 and my oxygen saturation nadir was 80%.

I wonder what accounts for the variation. Is it the equipment? Is it hey fever? Could it be because I had surgery in December and the intubation irritated my throat and it's been swollen? But it was almost 4 months since then.

Here's a question for Jason, the new recommendation for the lab that read the second study is for a titration study. Do I really need one considering Sleepy Head shows that over 3 months my AirSense 10 only went over 8.5 once? A pressure of 4-8 seems to be doing the trick.

Thanks,

Smokey


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diamaunt
Unread post  Post subject: Re: Two sleep studies, different equipment, different result  |  Posted: Thu Mar 10, 2016 11:30 pm
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sleep studies are brief snapshots in the ever changing continuum of your sleep.

you can look at a nights data with sleepyhead software and see that you don't sleep the same way all night long, nor do you sleep the same way from night to night.

imagine someone running down the street, take a picture of them, wait a bit, and take another picture, things will be different, they'll be in a different position, different place in their stride, different background....

sleep studies are like those two pictures.

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TheLankyLefty
Unread post  Post subject: Re: Two sleep studies, different equipment, different result  |  Posted: Sat Mar 12, 2016 12:30 am
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I think the variation can be from all of the above.

The methodology for each of those HSTs is different. ARES is supposed to have EEG, but it's auto scored and the data can be accessed and overridden. Auto scoring is notoriously horrible, mostly because of variation in the EEG patient to patient.

I know the PDx is capable of EEG, was it used in your case? I hope so if an RDI was reported.

The difference could be from difference in body position. The PDx is awesome. Very accurate. The ARES is head position.

Also, like what diamaunt said, there can be night to night variation. It's not usually this much though. We're the testing conditions of "you" fairly similar, or were there big changes. Alcohol, weight, illness....the surgery could have been it too. I wouldn't be able to say though.

I think another Titration study is a waste of money and time unless central apnea or complex sleep apnea is suspected. You already have an apap that seems to be working. Do you think there is a reason to do it? Sometimes this language is boilerplate about needing an in lab titration. Depends on how close the interpreting physician is to the patient and how well they know their medical history.

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Smokey
Unread post  Post subject: Re: Two sleep studies, different equipment, different result  |  Posted: Sat Mar 12, 2016 11:38 am

Joined: Sun Nov 01, 2015 1:56 pm
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Jason and diamaunt, thanks for your responses.

The PDx did not record EEG, the sensors that were attached were two effort belts--one chest and one abdomen, a nasal cannula, and a oximeter that was attached to my finger.

Both tests were done at home. Looking at the results of both, it looks like I spent 30% of my sleep on my back during the first test and 60% during the second. The second test shows that most of the obstructions happened when I was on my back so one of the recommendations is that I sleep on my side. I have a lot of hardware in one hip so it makes sleeping on that side uncomfortable.

There were no big changes from the from the first study to the second. My weight is steady, I don't drink, don't smoke, I wasn't ill. However, my dog jumped into my bed and was restless.

Some of the results of the PDx study seem wrong to me. For example, it says "Wake after sleep onset" is 0. I know I woke up at least 5 times that night. I remember having to reconnect one of the sensors that came lose, I had to reposition the finger oximeter a few times, and of course I had to drain the lizard.

I'm attaching the statistics and overview reports from Sleepyhead. You'll see that the pressure rarely goes over 9. Can the DME use this report to set the pressure? Based on the results do they really need to change anything. From what I can tell in the report, the therapy is working.

Thanks again,

Smokey


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