AHI not good metric to determine CPAP effectiveness

lazarus wrote: ↑

Sat Jan 07, 2023 3:36 pm

Objection: Asked and answered, Your Honor.

you just want to make sure i'm reading your posts, aren't you?

zonker wrote: ↑

Sat Jan 07, 2023 8:07 pm

lazarus wrote: ↑

Sat Jan 07, 2023 3:36 pm

Objection: Asked and answered, Your Honor.

you just want to make sure i'm reading your posts, aren't you?

You still read my posts? I figured you'd learned your lesson by now.

Tec5 wrote: ↑

Sat Jan 07, 2023 11:52 am

robysue1 wrote: ↑

Sat Jan 07, 2023 9:09 am

Simple question (asked again)
Is the attached overview graphic what you mean by “trending data”?
Yes, this is one way trending data can be presented.

Does OSCAR provide a better way of presenting "trending data"?

Oscar has two ways of presenting trending data.

First, the charts under the Overview tab give you a way of quickly seeing trends over various time frames. Of particular use for trending data is the AHI data and Sessions Times data. If a person is dealing with leaks, the Overview Leak data can also be useful to determine how often a person is dealing with significant leaks.

Second, the statistical data under the Statistics tab is another way of providing trending data.

robysue1 wrote: ↑

Sat Jan 07, 2023 8:55 pm

Does OSCAR provide a better way of presenting "trending data"?

Of particular use for trending data is the AHI data and Sessions Times data.
[/quote]
So I've added the sessions time graphic to the AHI graphic I asked about before. Is that sufficient to draw conclusions about treatment effectiveness?

In response to an extended explanation of a comples issue by robysue, (click on the arrow to see the whole text)

robysue1 wrote: ↑

Sat Jan 07, 2023 9:09 am

Tec5 extracted on sentence, and asked a "yes no" question.

Tec5 wrote: ↑

Sat Jan 07, 2023 7:46 am

Totally ignoring this part of the explanation (my emphasis in color):

robysue1 wrote: ↑

Sat Jan 07, 2023 9:09 am

If you are feeling pretty decent when you wake up each morning and your machine AHI is typically reasonably low, then there is a pretty high probability that your OSA is being well managed by your xPAP therapy. And there's no need to "add" additional data that requires additional equipment and time to analyze just to determine what you already know.

Conversely, If you are not feeling pretty decent when you wake up on most mornings AND you are using your xPAP all night long, every single night, you (and ideally your doctors) need to do some real investigation into what is still wrong with your sleep. Part of that is the obvious: Look at the trending data for AHI---if this is too high, then that's a pretty good indication that the xPAP therapy might not yet be optimized. Look at sleep fragmentation and leaks---if someone is waking up 6-10 times every night to turn the machine off and back on or there's a lot of leaking going on, that can explain why someone is not yet feeling better: You have to actually get some quality sleep for xPAP to make a difference. And, in particularly, if O2 desats were a significant problem on the diagnostic sleep study, it may very well be worth tracking O2 levels for a while and see if they correspond with flow limitations and micro-events that are not flagged as hypopneas or apneas because they don't last for 10 seconds.
[...]Trending data includes more than just the AHI. One other important trending data is the actual usage data: Looking at the number of hours used, the actual hours the machine is used, and the number of times the machine is turned off and back on over the course of several months is the easiest way to establish whether a person is both using their machine all night, every night AND whether that person is likely dealing with sleep issues tied to bad sleep hygiene and/or significant sleep fragmentation issues that might not be associated with under treated OSA.

And, quite frankly, if you are going through the trouble of collecting O2 data, the trending data for the O2 data is probably far more important than the O2 data for any particular night. If you have one rare bad night with a bunch of desats scored by the oximeter of your choice, that most likely doesn't indicate anything is wrong. If you frequently have nights with a significant number of desats, that probably does indicate you (and your doctors) need to be investigating things further.

Tec5 wrote: ↑

Sat Jan 07, 2023 9:57 pm

So I've added the sessions time graphic to the AHI graphic I asked about before.
[image attached]

Is that sufficient to draw conclusions about treatment effectiveness?

A one sentence quote from an extended explanation of a complex subject is of much use in generating useless discussion.

Anyone in search of real understanding should read - and if necessary re-read the whole explanation, and make their own mind(s) about the best way to monitor their own therapy.

ozij wrote: ↑

Sat Jan 07, 2023 10:58 pm

A one sentence quote from an extended explanation of a complex subject is of much use in generating useless discussion.

Anyone in search of real understanding should read - and if necessary re-read the whole explanation, and make their own mind(s) about the best way to monitor their own therapy.

Ozij,

Thank you for saying this.

I write my extended and sometimes complex explanations specifically because so many xPAP related issues are not simple and do not have "easy" or "short" answers.

As you pointed out, Tec5's trying to reduce what I wrote down to a "Yes/No" question appears to be designed to generate useless discussion rather than actually indicative of understanding what I actually wrote.

Tec5 wrote: ↑

Sat Jan 07, 2023 9:57 pm

robysue1 wrote: ↑

Sat Jan 07, 2023 8:55 pm

Does OSCAR provide a better way of presenting "trending data"?

Of particular use for trending data is the AHI data and Sessions Times data.

So I've added the sessions time graphic to the AHI graphic I asked about before.
AHI and Session Time overview.jpg

Is that sufficient to draw conclusions about treatment effectiveness?

Tec5, only you (and maybe your doctors) can answer your question of whether your xPAP therapy is effective.

I don't have the critical subjective data needed to actually answer your question whether your particular xPAP therapy is effectively treating your OSA. That critical subjective data includes answers to these questions that cannot be determined by either xPAP data or O2 desat data or a combination of both of them:

• Do you wake up feeling rested and refreshed most mornings?
• Do you have enough energy to get through the day and do the things you want and/or need to do each day?
• Are you still experiencing any of the symptoms of your untreated OSA? If so, what symptoms and has there been any improvement at all?
• Are you sleeping on a schedule that "works" for you in terms of your other obligations as well as how well your body feels? (Not every body is a morning lark, and night owls who can make a sleep window from 3 AM to 10 AM work with their job don't need to "fix" the time they're sleeping.)

Only you have the answers to those questions, but without the answers to those questions, neither I nor your docs nor anybody else can really say whether your xPAP therapy is effectively treating your OSA.

Having said that, I will add that your Sessions Overview data seems to indicate that you do not have a regular sleep schedule and that on most nights you have one or more wakes where you are waking up enough to turn the machine off and back on. Without any of the subjective data on how you are feeling, that Sessions data could indicate that you may have some sleep maintenance insomnia issues. Given the low AHIs, if you aren't feeling particularly rested or if you are still dealing with a lot of daytime fatigue and/or sleepiness, I would suspect that talking to your sleep doctor about healthy sleep habits (i.e. sleep hygiene) and their importance in establishing high quality sleep might do more to "optimize" your xPAP therapy than anything else. But if you are feeling rested and if you've got the energy you need to get through the day, then I'd say you're just one of those lucky people who can get decent quality sleep even if you do have a few wakes during the night and even though you don't have a well established sleep schedule. And in that case, I'd say your xPAP therapy is probably pretty effectively treating your OSA.

I'd also say that the fact that there are several days without any usage is more significant than the fact that the treated AHI is very rarely higher than 5.0: If you are regularly opting to sleep without your xPAP machine, that's important. On the other hand, if you are regularly pulling all nighters and just not going to bed, that's also important, but in a very different way than sleeping without the machine.

And if you're not feeling well, the fact that there is a slight uptick in the number of events since Dec 9 may indicate that there's something going on that is worth checking in with your sleep doctor. But this uptick could also easily be explained by something like an upper respiratory illness. There is no way to tease out from just the xPAP data whether that uptick in events is genuinely significant or not. I would need to have subjective data concerning how you actually felt between Dec. 9 and Dec. 31 in order to figure out whether this uptick is troubling enough to worry about or not.

So as you can see, any attempt to evaluate the efficacy of your xPAP data based on just the objective data gathered by your xPAP (or an xPAP plus O2 desat data) is going to fail: The subjective data about how you are feeling and whether your sleep feels as fragmented and as irregular as it appears to be is needed to answer your basic question, "Is my xPAP therapy effective?"

In the long run, what objective data you chose to monitor to evaluate your therapy has to be done in connection with monitoring the appropriate subjective data.

In my case? That means looking at my AHI now and then when I'm sleeping well. And when I'm not sleeping well, it means looking at my AHI and my session times and (the not exceptionally reliable) FitBit data for evidence of sleep fragmentation. If the AHI is reasonable, but there's evidence of sleep fragmentation, then I know I've got to go back to using the CBT-I techniques that I know work for me in terms of minimizing the sleep fragmentation and sleep maintenance insomnia issues.

But then, I didn't have O2 desats on my in-lab diagnostic PSGs (two of them) and I never had O2 desats on any of my in-lab titration studies (four of them). So for me, I see no point in adding monitoring O2 data to the mix of stuff that I will look at when trying to snip a potential sleep problem in the bud.

@robysue1;
To begin, thank you for your very complete answer and I'm in agreement with you that the AHI (objective data) is insufficient to evaluate PAP effectiveness.

In addition to the subjective "data" you mention:

Do you wake up feeling rested and refreshed most mornings?
Do you have enough energy to get through the day and do the things you want and/or need to do each day?
Are you still experiencing any of the symptoms of your untreated OSA? If so, what symptoms and has there been any improvement at all?
Are you sleeping on a schedule that "works" for you in terms of your other obligations as well as how well your body feels? (Not every body is a morning lark, and night owls who can make a sleep window from 3 AM to 10 AM work with their job don't need to "fix" the time they're sleeping.)

The doctors (in the video, the top of this thread) seemed to be focused on holistic treatment of patients of OSA, not simply the effectiveness of CPAP therapy, consequently they were suggesting additional objective data is useful to complete the picture.

Your response reinforces the title of this thread "AHI is not a good metric to determine CPAP effectiveness", however , as someone else said, AHI (by itself) is incomplete. That "incompleteness" is what you've correctly highlighted.

My questions were not intended to focus on a specific individual's treatment, but I offered the "overview tab" as an example of what a person might want to do to extract "objective" data from OSCAR to aid in evaluating therapy effectiveness.

So, as it applies to the that graphic:
1) the several days of non-use were travel days where a portable PAP was used (and data not incorporated into OSCAR) to the principle "in home" machine.
2) The breaks in nightly usage are almost always arousals to "potty" the consequence of prescribed HCTZ (aka "water pill") together with an enlarged prostrate.
that limits bladder capacity . The prostrate issue is particularly problematic in that despite an urge to urinate, it sometime takes 10 minutes or more to actually urinate..... by that time fully awake and return to actual sleep is difficult.
3) The slight uptick following Dec 9 may have been caused by a moderate cough/congestion that was treated with OTC Mucinex on and off for 3 weeks.

To wrap up and not focus on my problems, I'd propose that AHI data alone is probably not the "best" to evaluate an individual's CPAP therapy effectiveness.

I'm thinking that you would agree.

I personally have self-monitored my OSA treatment for decades. If I consistently see low AHI, I assume all is well. But periodic OSCAR or RESCAN is important. I notice trends that are important aside from AHI.

I view self-monitoring xPAP treatment as important as diabetic monitoring blood sugar except on longer time frame. My sleep doctor only looks at general data like compliance and AHI. But I have shown him graphs that AHI can hide problems because averaging. I might have 7 hours with zero events. But an hour with high number of events with cumulative AHI above 10 during that hour. He even commented that I "knew more about interpreting xPAP data than he did." A likely truthful remark for all sleep doctors. The sleep technicians are much better at understanding nuances in data.

If you are only looking at AHI, you might miss you are having periodic major leaks likely during REM so machine misses events. There are many things that you won't know about that change over longer time frames. Decrease in spontaneous breathing, tidal volume, increasing respiratory rate, inspiration time. Appearance of more CA mixed with decrease in obstruction or hypopnea. More RERAs.

I have to disagree with "how you feel" as way to judge efficacy long-term. For new CPAP patients who had daytime sleepiness, this is good, general approach along with AHI. Long-term, not so much. Our physiology needs change over time. Much can be learned from xPAP data. CPAP even known to have some negative effects long-term. Increase in airway stiffness, decrease in respose to buildup of CO2, decrease in REM sleep.

If you want best outcome for yourself, review your machine data periodically.

Uncle Nico may be in the O2 Ring selling business but, he looks convincing, showing that the PSO2 reporting may be useful.
For exemple, in a case with good AHI and poor O2 reporting, reviewing the settings, leading to a better O2 and the acceptance of a related deterioration of the AHI.

Makes sense ?

https://www.youtube.com/watch?v=Ebg9-5l ... PAPReviews

I don't look to social-media entertainment personalities who are in the online-trinket-selling business for scientific insights on medical data, much as I don't consult the bank janitor for financial guidance or trust the consumer research claims of the local used car salesman.

Hey, just me.

But I do understand those who follow the Steve Martin belief system:

"I guess I wouldn't believe in anything anymore if it weren't for my lucky astrology mood watch."--Steve Martin -- https://www.goodreads.com/quotes/71836- ... ore-i-mean

Act now, and we'll include a matching O2 Ring!

Congratulations to Robye Sue for putting things in perspective. We Newbies, learn a lot.

Thank you

lazarus wrote: ↑

Mon Jan 09, 2023 7:56 am

I don't look to social-media entertainment personalities who are in the online-trinket-selling business for scientific insights on medical data, much as I don't consult the bank janitor for financial guidance or trust the consumer research claims of the local used car salesman.

Hey, just me.

But I do understand those who follow the Steve Martin belief system:

"I guess I wouldn't believe in anything anymore if it weren't for my lucky astrology mood watch."--Steve Martin -- https://www.goodreads.com/quotes/71836- ... ore-i-mean

Act now, and we'll include a matching O2 Ring!

Fellow Steve Martin Fan here

PS. I really hate the O2 Ring, and other Viatom Gadgets. They just aren't accurate. Please don't point that out to anyone. Especially Nicko. He doesn't react well to it