OSA - RDI or AHI

[sparky_wulf]

I am confused looking backwards at two sleep studies that ruled out OSA.

First study -
AHI of 2.7
Awakening index of 22.1 (is this RDI?)

Also of note - REM stage of sleep had an AHI of 5.2

Sleep efficiency 44%

Second study
AHI of 1
RDI of 15
Supine RDI of 24

of interest based off of this article:


http://www.aasmnet.org/Resources/clinicalguidelines/OSA_Adults.pdf

AASM diagnostic criteria for OSA
According to the Centers for Medicare & Medicaid Services criteria for the positive diagnosis and treatment of obstructive sleep apnea,[32] a positive test for OSA is established if either of the following criteria using the AHI or the RDI is met:

• AHI or RDI greater than or equal to 15 events per hour, or
• AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness (EDS); impaired cognition; mood disorders; insomnia; or documented hypertension, ischemic heart disease, or history of stroke

I believe from this information I should be diagnosed with OSA and from the CFR I am warranted 30% because I have SERIOUS daytime hypersomnolence.

Thoughts?

 

[AvnSgt]

I am confused looking backwards at two sleep studies that ruled out OSA.

First study -
AHI of 2.7
Awakening index of 22.1 (is this RDI?)

Also of note - REM stage of sleep had an AHI of 5.2

Sleep efficiency 44%

Second study
AHI of 1
RDI of 15
Supine RDI of 24

of interest based off of this article:


http://www.aasmnet.org/Resources/clinicalguidelines/OSA_Adults.pdf



I believe from this information I should be diagnosed with OSA and from the CFR I am warranted 30% because I have SERIOUS daytime hypersomnolence.

Thoughts?

There is a third factor that should be considered, and that is your Oxygen levels, during the studies. Also, the Sleep Lab should conduct a MSLT, which will confirm the hypersomnolence, and determine if any additional issue appear. However, I don't think the VA or military have the time to conduct this study. I had to have to have my MSLT conducted by an outside Sleep Lab, and Physician.

 

[scoutCC]

RDI is considered an old measurement, it being the standard before they started measuring AHI. It includes data about just waking up, which is simply noise if diagnosing apnea. Most docs will look at AHI, which only measure times you don't breathe. AHI over 5 is indeed the rule for apnea, but they consider the average over the night, not specific times only. Most hate taking apnea seriously below a AHI of 10. CPAP is sucessful if it moves you below 5, so without a 50% improvement, is the treatment worth it? Apnea events are common for everyone, they need it to be of a specific quantity to be concerning. It may be something besides sleep apnea causing problems. Not to mention the test doesn't tell if its OSA or central apnea causing the trouble.

I know JBLM will conduct a daytime sleep lab if they get data from one of thier tracking watches suggesting the need. It gives them data suggesting you are falling asleep very quickly. You may be able to get a doc to order one based off just your answers the questionaire, EEP or whatever it is called. That's if hypersolomence is the problem. Are you falling asleep at crazy times, almost narcoleptic, or just fatiqued and tired?

I was surprised to find prozasin to help me with incredibly horrible daytime sleepiness. Its the standard med for nightmares. I don't remember my dreams, so never asked for help with nightmares. Wife says I'm restless when I sleep and sweating during sleep was common, so shrink said try it. Titrated up to max he recommended and wife said each upgrade made me easier to sleep with. I'm surprised to find I am indeed feeling better.

Keep with the problem, keep demanding solutions until the symptoms are squared away. If they won't give you a CPAP to try (trust me, it sucks anyway), maybe something they do try will help. Modafanil is standard response to CFS I think, they tried it with me and it didn't help. It is a med that triggers a MEB automatically I've been told though. If it works. Could be depression. Could be thyroid. Could be something else entirely, or multiple conditions together. Put your symptoms into google and the joke is you'll find out you have cancer.

Being tired is caused by a whole slew of conditions. Don't fixate on apnea.

 

[AvnSgt]

Being tired is caused by a whole slew of conditions. Don't fixate on apnea.

If you can get a good Physician, he or she will put in the work up, to discover the causes. There are a slew of tests that can be done to eliminate all the surrounding issues. For me though, I had to start with my Primary Care, and Pulmonary Physician, who made a quick work up on what the VA missed. Especially, since the VA did not do follow up sleep studies to adjust the CPAP machine. Turns out this was a big problem, that lead to additional issues 4 years later.

So, as scoutCC says, don't fixate on the one issue.

 

[danieldresen]

I had an outside sleep study with day time observation because I was sleeping while driving at times... Mixed Apnea. I am having a surgery so the CPAP can limit the obstructive apneas but as for the central... no idea. They are hoping once the obstructions are down, the central follows. If not, I may need an MRI to find out what is going on.

 

[sparky_wulf]

Thanks for the responses!
I'm definitely not fixated on apnea - but trying to assure that as my case goes, inevitably, to a MEB I have all of my bases covered!

I'm awaiting a diagnosis of bipolar with some sort of anxiety disorder. MEB is def in the future with that one. The docs are all positive it's there and are just jumping through the official hoops for diagnosis. I know this alone could be a cause for my sleep issues - except for the fact that my sleep is consistently bad no matter what side of bipolar I'm hanging out in.

Right now my goals are: 1) Get a correct diagnosis for whatever mental issues are going on (or none, if that's correct [but it isn't]). 2) Get an appropriate treatment plan put together so this thing can stop dicking up all aspects of my life. 3) Get down the MEB path if appropriate. 4) Finally get someone to look at this Earthmover's lungs for real - not just looking for asthma. 5) get EVERYTHING else appropriate diagnosed/papered.

This falls under goal 5.