Titration results - they think he no longer needs O2 bled in

[ejackson1200]

Hi,

We live in the US in Ohio. I'm wondering about the standard for discontinuing his oxygen. He's been on 3L at night with his cpap for the last 10 years and the person who called the results said they can ordered him a new cpap - his is 10 years old - and he can discontinue his oxygen. He had 10 arousals an hour on average and his 02 sat was at or below 88 for 45 minutes out of 373 asleep (12% of the time) and never even went into State N3 or Rem sleep.

[Julie]

I would have other questions besides just the 02, which wasn't below the cutoff line of 88 as such, but wasn't that high either normal being in the high(er) 90s most of the time.

Why was he prescribed such a high (16) setting and (presumably) on a plain cpap vs an autopap which would give more options and less potential for future problems at that setting.

I'd want to talk to another sleep doctor altogether, in fact and talk about various issues, especially at his age.

[Pugsy]

Who was the person who called and told you that added oxygen was no longer needed?
Someone from the sleep lab or the doctor's office or the doctor's nurse or the doctor himself?

[ejackson1200]

The titration study was a follow up to a 3 days hospitalization for low o2 sats and feeling generally horrible. (He was testing 85- 89 at home - ER got similar results. He was transferred to a bigger hospital and admitted. No fever or other signs of COVID - blood work, lungs showed a "small" PE that they said was nothing but there was extra fluid that was keeping the air from getting into the small sacs - heart checked out ok. They wound up putting him on a bipap 4 hrs on 4 off for 24 hours and it seemed to do the trick of bringing his o2 sat back to normal. So the titration sleep study was then ordered to test and see if he needed a bipap.)

He received a call from the Dr's office staff saying his results were in and he no longer need oxygen bled in at night, they would order him a new machine, and he needs a pressure of 16. I called in and left a message that I'd like the actual results. Above are the results. I've asked for more detailed results as it looks like they never tried the bipap. It also looks like he never entered N3 and Rem sleep and if I'm reading things correctly both of those tend to have higher levels of apnea. Is the fact that he woke multiple times an hour and didn't enter N3 and Rem very unusual and something I should be concerned about in general? (He doesn't sleep well due to pain and walks up multiple times a night at home but not 6 times an hour.)

We both currently use S-9's - the Dr himself really likes the Airsense10's with the mobile apps but is there a good reason to upgrade?

Is it possible/likely that a bipap would not require as much pressure and/or result in better O2sats?

I'd love to have him off the oxygen but not if it means his O2 will be less than 88 for 12% or more of the time he's sleeping.

Eileen

[Miss Emerita]

I wouldn't describe an AHI of 4 as "well-controlled" apnea, and I also wouldn't be satisfied with a MEAN O2 sat of 90.5 and O2 sats at or below 89 for 45.7 minutes. Especially given the history, I would suggest that you advocate strongly for continuing the O2 bleed.

It would also be good to have an oximeter to see what is going on during the night. If you have a laptop or desktop computer, I would strongly recommend downloading the Oscar software: https://www.sleepfiles.com/OSCAR/ There are several oximeters whose data Oscar can import along with the data from your PAP machine:

http://www.apneaboard.com/wiki/index.ph ... _Oximeters

A bi-level machine could provide more pressure support to help with inhalation and improve O2, I believe, but it could also not help. It would probably be worth trying. I would strongly recommend a ResMed VAuto.

Is the sleep doctor a pulmonologist? Is the pulmonologist who treated him in the hospital looped into these discussions? If not, that could be valuable.