AHI not good metric to determine CPAP effectiveness

[25YearsOnCPAP]

Watched great YT video from Mayo Clinic expert on OSA and Cardiovascular Disease.
State-of-the-Art Sleep Apnea and Cardiovascular Disease
https://youtu.be/56Z4cwZZuII

He says AHI is poor metric to measure effectiveness of CPAP therapy. That AHI can be great but sleep apnea patient on CPAP can be having sleep fragmentation, hypercapnic load and cardiac issues. Periodic re-evaluation of pulse oximetry, blood pressure/heart rate and EEG may reveal conditions hidden by a good AHI and compliance. This is excellent point and a reminder that preventing apnea events not whole picture.

[lazarus]

In my nonexpert opinion: Although it is true that some people with multiple health conditions may need more info than AHI alone for evaluation of overall health and overall sleep, that does not change the fact that AHI is often quite sufficient for evaluating how effectively an airway is being stabilized for someone with uncomplicated OSA.

[chunkyfrog]

In my nonexpert opinion: Although it is true that some people with multiple health conditions may need more info than AHI alone for evaluation of overall health and overall sleep, that does not change the fact that AHI is often quite sufficient for evaluating how effectively an airway is being stabilized for someone with uncomplicated OSA.

I agree.
For most of us, AHI is close enough.
All that other testing may not even be covered by insurance,
meaning not available for the 99%-ers. (us)
Maybe a nice cash cow for the doctor and his facility.

[Tec5]

I agree.
For most of us, AHI is close enough.

Nocturnal oximetry is inexpensive, and IMO contributes significant insight into effectiveness of therapy (as well as cardio-vascular and neurologic burden)

But suit yourself, if AHI is close enough then MYAIR app is free and easy.

[chunkyfrog]

I have access to the SCREEN.
Why bother with Myair?

[ChicagoGranny]

But suit yourself, if AHI is close enough then MYAIR app is free and easy.

I might have uncovered your problem. You think there are no options between a very basic myAir and an expensive in-lab PSG.

[robysue1]

That AHI can be great but sleep apnea patient on CPAP can be having sleep fragmentation, hypercapnic load and cardiac issues. Periodic re-evaluation of pulse oximetry, blood pressure/heart rate and EEG may reveal conditions hidden by a good AHI and compliance. This is excellent point and a reminder that preventing apnea events not whole picture.

Many things other than OSA can cause sleep fragmentation and poor quality sleep. If you are not sleeping well because of things that are not related to your OSA, then xPAP is unlikely to fix all your sleep problems.

As far as the rest of this goes---if a patient with OSA is using their xPAP all night long and the AHI is low and they are not feeling rested when waking up, then yes, stuff should be re-evaluated by a professional---particularly if they once were feeling good while using their xPAP machine.

[Tec5]

I might have uncovered your problem. You think there are no options between a very basic myAir and an expensive in-lab PSG.

What would make you imagine I've got a problem?

Chunky said "AHI is close enough".
If all you want is AHI then MYAIR free and easy.

I know that there are lots of options between MYAIR and in-lab PSG, but if just AHI is "close enough" then why look any further then the basic Myair, or as Chunky said "the SCREEN", easier yet

[lazarus]

Nocturnal oximetry is inexpensive, and IMO contributes significant insight into effectiveness of therapy

Someone with significant lung disease or cardiovascular disease or morbid obesity may have a reason to wonder about sustained O2, but an otherwise healthy adult with simple OSA will learn nothing significant from an oximeter, since sustained O2 gets corrected at much lower pressure(s) than what is needed to stabilize the airway, as indicated in the AHI.

[25YearsOnCPAP]

"an otherwise healthy adult with simple OS "

That is a conundrum. Very few OSA patients have no other health problems. Many have obesity, hypertension, hyperlipemia, metabolic syndrome, atrial fibrillation associated with OSA. Don't have to be morbidly obese to have serious OSA-related problems. A fortunate few may be lucky to start OSA treatment before onset of other health problems.

[robysue1]

"an otherwise healthy adult with simple OS "

That is a conundrum. Very few OSA patients have no other health problems. Many have obesity, hypertension, hyperlipemia, metabolic syndrome, atrial fibrillation associated with OSA. Don't have to be morbidly obese to have serious OSA-related problems. A fortunate few may be lucky to start OSA treatment before onset of other health problems.

And many of us, including both my husband and I do not have any other health problems of note.

Other than my well treated OSA & chronic insomnia, my only other health issues are migraine headaches and a TMJ disorder. My husband? About the only thing he has is some accident related arthritis caused by a near head-on collision at highway speed back in 1995.

[lazarus]

Yes. Someone with OSA may have other conditions. But that is not a basis for making the logical jump that monitoring the effects of those conditions then becomes a better way or an important way to trend the effectiveness of OSA treatment.

Yes. People without weight problems may have OSA, but my point was that people who are severely overweight may have hypoventilation problems somewhat independent of classic OSA.

Disease states interact. But that does not provide a scientific argument of how best to monitor trending for ascertaining whether PAP is successfully stabilizing the airway.

I am unaware of any case studies or anecdotal evidence that patient-monitored O2 ever proved useful info for dialing in treatment pressures for OSA. I have, however, read of patient-monitored home-treatment-machine-reported AHI being useful for that purpose.

Is anyone aware of any patient who first noticed OSA-treatment-pressure problems from an overnight recording pulse-ox BEFORE problems presented in the trending home-treatment AHI? Maybe it has happened and I just don't know of it. It would be interesting if that has happened.

[lazarus]

. . . not have any other health problems of note.

Other than my well treated OSA & chronic insomnia, my only other health issues are migraine headaches and a TMJ disorder.

I consider that quite a load: insomnia, TMJ, migraines. But I appreciate your consistently positive perspective, RS.

[Tec5]

I am unaware of any case studies or anecdotal evidence that patient-monitored O2 ever proved useful info for dialing in treatment pressures for OSA.

I'm not sure what point you are trying to make.
Are you suggesting that people who wear Oura rings (or similar) and transfer that info to OSCAR are wasting their time and money? Nocturnal desaturations provide no value?

(admittedly, I am a advocate of collecting as much data as possible when trying to solve problems, nocturnal oximetry is cheap , easy, and may be useful)

[dataq1]

AHI is often quite sufficient for evaluating how effectively an airway is being stabilized for someone with uncomplicated OSA.

SO ..... no value to observe pulse-ox readings during a titration study ?????