redid a take home sleep test and results simply said "Normal HSAT"?

[CPAPSteve]

So I asked a while back about getting off of CPAP because I had lost a decent amount of weight and was annoyed by the extreme dry mouth I'd occasionally get when using CPAP (never got it when I wore a HARD cervical collar but sleeping wearing that just isn't natural to anyone). While I don't hate my CPAP by any stretch of the imagination that I opted to get a test redone.

My doctor barely got any details from the sleep clinic other than "you're client was referred to us and their HSAT test is normal". HSAT = home sleep apnea test

No figures, stats anything... nada. They informed my doctor that they would be reaching out to me in 6-12 months since my issue is considered non-severe.

So my question to you all is:
1. If my HSAT is normal, and normal is what I think normal means then I don't have sleep apnea?
2. Why would the hospital even tell my doctor that they'd call me in in 6-12 months b/c I'm a non-severe case? If my HSAT is normal then can they not just tell me I'm fine and I stop using CPAP?
3. Due to me occasionally having difficulties falling asleep the referral form (that came BACK from the hospital sleep clinic) also did mention cognitive behavioral therapy for insomnia but I'm not really someone that suffers from that (at least I didn't think I did). I know the sleep clinician person did ask if I had trouble sleeping and I said sometimes but that is because of other stressors in life and the fact that I probably have my smartphone on longer than I'd like to admit.

From your folks' experience when my home test comes back with normal HSAT is it a safe assumption that I am perfectly normal?

[Julie]

Maybe they want to see you again (retest?) in six mos, a year, because they know so many who lose weight gain it back later and maybe apnea will come back with it. Not that you have to be overweight to have it, and it's now thought the weight may be because of the apnea, but it's how they think, and want to be sure about you.

[Pugsy]

If my HSAT is normal, and normal is what I think normal means then I don't have sleep apnea?

It means you didn't have an AHI of 5 or greater to earn the OSA diagnosis. Doesn't mean you didn't have any events...just not enough to qualify for the criteria to earn the diagnosis. It wouldn't have been impossible for the home study to come with an AHI of 4.9...not enough to earn the diagnosis but potentially still a problem if you have other symptoms or health issues that might point to even that low of a number of events still causing a problem. I would make an official request for the full data report from that home study...that data is there but you will likely have to force them to give it to you. They can't deny it.

Why would the hospital even tell my doctor that they'd call me in in 6-12 months b/c I'm a non-severe case? If my HSAT is normal then can they not just tell me I'm fine and I stop using CPAP?

Have no idea but maybe they are just doing follow up to see if any symptoms might have gotten worse or new co morbid factors might have popped up or something.

when my home test comes back with normal HSAT is it a safe assumption that I am perfectly normal?

Well maybe not perfectly normal but normal enough to not have an AHI that earns the diagnosis.
These places go by AHI alone as the standard for diagnosing OSA but there are other factors besides just the number of events that can impact a person. There's a lot more to Sleep Disordered Breathing than just AHI.

But...if I had a comprehensive sleep study that came back with a nice low AHI and I wasn't having any other issues....I would certainly consider putting the cpap machine in the closet for a while and going without and seeing how I did.

BUT I would make sure exactly what the sleep study showed and wouldn't accept what you were given.
Was your AHI 1.0 or maybe 4.9????
What range do they use for "normal"...some places use AHI less than 15 per hour average as being so mild it doesn't need treatment as long as there aren't other complicating factors like blood pressure or excessive sleepiness issues.
It is normal to have a few apnea events...everyone will have some sort of apnea event on occasion...they are only a problem when we have too many of them or they really screw up our sleep or cause oxygen level drops.

[CPAPSteve]

Thanks for all the feedback. I tried to ask for the actual results but they said it was sent to my doctor but really all they sent was the referral form indicating they will call me in 6-12 months and not an ounce of additional info.

I don’t doubt that cpap helps. Night sweats and frequent urination has stopped. What is even more ridiculous is since I had my sleep test done in early June that my weight is slowly creeping back up (my weight tends to yo-yo a fair bit - i swear I gain weight by breathing).

No harm in using cpap during the waiting period. I have come to like and appreciate my machine sans MY issue with my mouth breathing that causes dry mouth.

How I came to this sleep clinic at the hospital was because HSATs are no longer covered by our healthcare system using private providers. Only hospital sleep clinics will cover it and according to them it is the standard triage process that they use for all incoming patients. For all I know I may never hear from them.

[Pugsy]

You may have to make a formal request for the full report and hold the threat of HIPAA over their heads...if you are in the USA.
They can't deny it...now they may make you pay for it but they have to give you the full results if you request it.
Now if you aren't in the US....I don't know about health record document release in other countries.

[southerndoc]

You may have to make a formal request for the full report and hold the threat of HIPAA over their heads...if you are in the USA.
They can't deny it...now they may make you pay for it but they have to give you the full results if you request it.
Now if you aren't in the US....I don't know about health record document release in other countries.

The CURES Act requires that any test result be made available to the patient immediately or the healthcare agent will face fines.

I have patient's get their CT results showing cancer before I've had a chance to talk to them. It's the law. Every test result must be made available to the patient immediately unless there is concern it can jeopardize the patient's life (e.g., a note describing domestic violence where the significant other might obtain the report) or if the patient is a minor and a result might be seen by the parent (STD). The one limitation, however, is that the provider must have electronic access available (i.e., if they don't have a computerized record system, then they may be excluded).

HIPAA does not apply as it prevents the unauthorized sharing of information instead of requiring sharing of information.

https://www.healthit.gov/curesrule/

[Pugsy]

You may have to make a formal request for the full report and hold the threat of HIPAA over their heads...if you are in the USA.
They can't deny it...now they may make you pay for it but they have to give you the full results if you request it.
Now if you aren't in the US....I don't know about health record document release in other countries.

The CURES Act requires that any test result be made available to the patient immediately or the healthcare agent will face fines.

I have patient's get their CT results showing cancer before I've had a chance to talk to them. It's the law. Every test result must be made available to the patient immediately unless there is concern it can jeopardize the patient's life (e.g., a note describing domestic violence where the significant other might obtain the report) or if the patient is a minor and a result might be seen by the parent (STD). The one limitation, however, is that the provider must have electronic access available (i.e., if they don't have a computerized record system, then they may be excluded).

HIPAA does not apply as it prevents the unauthorized sharing of information instead of requiring sharing of information.

https://www.healthit.gov/curesrule/

Thanks for the clarification. The problem here is he has his results....but not full report. He needs the full report and not a brief one line summary. Somebody somewhere has it...but he may have to rattle some cages to get it given to him.

[southerndoc]

They're required to give a full report and not just the impression.

It's always fun when I get a phone call from a patient that read their ER visit note and see that I've dictated that it's likely anxiety or talk about their drug use being the cause of their system.

[Pugsy]

It's always fun when I get a phone call from a patient that read their ER visit note and see that I've dictated that it's likely anxiety or talk about their drug use being the cause of their system.

I could always understand people wanting to go into denial mode when the docs talk about anxiety (they don't like perceived physical symptoms being all in their head)....but I have no sympathy when it comes to drug use...they know if they are taking drugs...legal or not.

People probably should read those notes though because errors can be made. I was looking at my husband's a while back and they had him down with a diagnosis of "history of diabetes"....and he's never ever had that diagnosis nor any lab results that would earn him that honor. I don't know where they pulled that one from.

Hopefully OP here can get the full details sooner than later and clear up some of the questions he has.

[CPAPSteve]

So it turns out my doctor did have all the information from the sleep study.

Here is how my test unfolded in this order (it was technically done backwards b/c of a miscommunication of what I was seeking which was a re-evaluation of my OSA). The reports are "SnoreStat".

1. Initial test was done hooking up a flow meter to my CPAP machine. I slept with the flowmeter and wires hooked up to me for 2 nights. First night it showed that it collected AHI data nd oddly the 2nd night the sensing system didn't detect any flow (weird b/c I checked everything thoroughly before sleeping on night #2).
2. Took tester back to clinic and asked clinician how doing a flow test on my CPAP would tell me that I could get off of CPAP? Clinician then asked "Strange, on the referal it simply said to test for CPAP efficacy and not a diagnostic". Was told to stop using CPAP for at least a few days before they can do a diagnostic test
3. 4 days pass and I am given an HSAT to take home with a nasal cannula and the usual sending wires (vs the flow meter used previously) to perform a diagnostic test. Looking at AHI alone it looks like my initial diagnosis done 3 years ago is similar to what the hospital found the only difference is rather than being told I am borderline OSA that I may have UARS.

Here are the results. I'll let you fine folks dissect the results. Given that when supine that my AHI is 6.3 and non supine I'm 2.2 that I could be borderline OSA like what was I was told back in 2018. Please note that the June 6th results was the 2nd night with the flowmeter hooked up to my cpap that clearly wasn't working right. What I don't get is HOW on earth me being on CPAP would result in an AHI of 13.1 yet with NO cpap I have an AHI of 4.7. What did change for the better is good oxygen saturation when on CPAP. barefly dipped below 90% SpO2.

Cheers!

[CPAPSteve]

Thoughts anyone?

[Pugsy]

Trying to come up with some thoughts and my first one was if that were my report I would be sleeping on my side.
Without cpap.

I don't know about UARS here...you know it's a hard diagnosis to make and most often it's made when they can't explain persistent symptoms without OSA diagnostics....either essentially negative diagnosis for OSA or persistent symptoms in the face of cpap treatment showing essentially no apnea event but symptoms persist.
The only real way to know about UARSis an in lab sleep study with a Pes device. Not many labs do it and not many people want to do it.

You are borderline... it's your choice whether you think you feel better with or without using cpap and your choice how to proceed.

What I don't get is HOW on earth me being on CPAP would result in an AHI of 13.1

My first thought...fluke night and most likely a lot of SWJ flagged events.

[CPAPSteve]

Hmm interesting Pugsy.

I thought the same thing too about sleeping on my side but that isn't likely going to happen. I sleep on my right and my nose blocks up. I sleep on my left and eventually my arm and shoulders fall asleep or ache. I do this weird rolling around bit in my sleep and my wife says that I end up looking like a giant burrito in the morning sleeping not quite on my back but not quite on my side and almost perfectly angled at 45 degrees. She says I use her as a body wedge to sleep like that.

I guess I'll just keep cpap-ing away because my crazy night sweats and frequent nighttime urination issues disappeared when I started using it. I guess I could try to stop using it for a week or two but it just feels so weird to NOT use it now.