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CPAP for hypopneas?

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CPAP for hypopneas?

Postby Mom2sleepyson » Fri May 06, 2011 1:53 pm

My teenage son recently had a sleep study. He only had one OSA, but had a lot of hypopneas. The sleep doctor is recommending we see an ENT to evaluate surgical options for two reasons: 1) she says teens won't wear CPAPs, and 2) she says insurance won't pay for a CPAP with just hypopneas. It doesn't seem to make a lot of sense to me that insurance would pay for surgery, which it seems should cost more and have a higher risk, but not pay for a CPAP. We do have an appointment with an ENT for an evaluation, but the sleep doctor is also trying to get us a trial run on a loaner CPAP at my insistence. My son is exhausted all of the time, and his quality of life and education are really suffering. Has anybody had success in treating hypopneas with a CPAP or surgery? Was it covered by insurance?

Thanks!
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Re: CPAP for hypopneas?

Postby Daniel » Fri May 06, 2011 2:03 pm

Mom2sleepyson wrote:My teenage son recently had a sleep study. He only had one OSA, but had a lot of hypopneas. The sleep doctor is recommending we see an ENT to evaluate surgical options for two reasons: 1) she says teens won't wear CPAPs, and 2) she says insurance won't pay for a CPAP with just hypopneas. It doesn't seem to make a lot of sense to me that insurance would pay for surgery, which it seems should cost more and have a higher risk, but not pay for a CPAP. We do have an appointment with an ENT for an evaluation, but the sleep doctor is also trying to get us a trial run on a loaner CPAP at my insistence. My son is exhausted all of the time, and his quality of life and education are really suffering. Has anybody had success in treating hypopneas with a CPAP or surgery? Was it covered by insurance?

Thanks!


Sleep Apnoea severity is measured by the AHI, which is the average number of apnoeas PLUS hypopnoeas per hour of sleep.......NOT the average number of apnoeas.
IMHO, hypopnoeas can be just as dangerous (if not more dangerous) as they include an oxygen desaturation of at least 4%. Apnoea events DO NOT have to include a desaturation.

What age is your son, and what was his AHI ? What was his desaturation level, and was it prolonged ?
Before going any further I strongly suggest that you get a copy of the full sleep study report.

Best of luck.

Daniel.
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Re: CPAP for hypopneas?

Postby robysue » Fri May 06, 2011 2:24 pm

Mom2sleepyson wrote:My teenage son recently had a sleep study. He only had one OSA, but had a lot of hypopneas. The sleep doctor is recommending we see an ENT to evaluate surgical options for two reasons: 1) she says teens won't wear CPAPs, and 2) she says insurance won't pay for a CPAP with just hypopneas. It doesn't seem to make a lot of sense to me that insurance would pay for surgery, which it seems should cost more and have a higher risk, but not pay for a CPAP. We do have an appointment with an ENT for an evaluation, but the sleep doctor is also trying to get us a trial run on a loaner CPAP at my insistence. My son is exhausted all of the time, and his quality of life and education are really suffering. Has anybody had success in treating hypopneas with a CPAP or surgery? Was it covered by insurance?

Thanks!
While the question of whether a teen will sleep with a CPAP depends on the teen, insurance companies will CLEARLY pay for CPAP machines when the AHI is made up entirely of hypopneas. Contact your insurance company and ask if you don't believe me.

Now it is true that Medicare (and maybe Medicaid) and some private insurance companies require that the hypopneas be scored under something called the AASM AHI_Recommended standard instead of the AASM AHI_Alternative standard. Here are the two different standards:

    AASM AHI_Recommended standard: Hypopneas are required to have ≥ 30% airflow reduction that lasts at least 10 seconds and ≥ 4% desaturation.

    AASM AHI_Alternative standard: Hypopneas are required to have ≥ 50% airflow reduction that lasts at least 10 seconds and (either a ≥ 3% desaturation or an arousal)


Labs are supposed to indicate which standard they are using when scoring sleep studies. It's important to realize that in the AHI_Alternative standard, the hypopnea does NOT need to have an accompanying desaturation IF the reduction in airflow is sufficiently great and there's an arousal present in the EEG. These "hypopneas with arousal (but no desaturation)" cannot be counted as an hypopnea under the AHI_recommended no matter how much the air flow is decreased and no matter how long the decreased air flow lasts before the arousal.

So there's a remote chance that you could have problems with the insurance company if they insist that the hypopneas be scored under the AASM AHI_Recommended standard and the vast majority of your son's events were "hypopneas with arousal (but no desaturation)" that were scored under the AASM_Alternative standard.

If you haven't already done it, ask for a copy of the sleep study report complete with ALL the summary graphs and summary information.

Finally, regardless of the definition of "hypopnea" used to score the sleep study, CPAP is considered the gold standard treatment for people with OSA even when all of the events are hypopneas instead of apneas. It's highly effective (for those who sleep with it EVERY NIGHT, ALL NIGHT LONG), is non-invasive, and uses a benign substance (slightly pressurized room air) to prop the upper airway open. The real problem with CPAP therapy is compliance---i.e. sticking with the therapy long enough to work out comfort issues that are present at the beginning when the idea of sleeping with a hose on your nose seems overwhelming. And there are a lot of things to get used to. And in the short run, some people have major problems with aerophagia and insomnia issues and feel as though they slept better without the mask than they do with the mask. These problems CAN be overcome with patient education and support and by a patient who is willing to WORK at making the therapy work instead of expecting instant gratification in terms of relief of daytime sypmtoms.

Best of luck to your son.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Postby Mom2sleepyson » Fri May 06, 2011 2:29 pm

Son is 15. I don't have a copy of the full report yet. There was an index of 20.1 that I think referred to hypopneas only. Saturation did not drop much, it stayed between 92% and 98%. I have a question in to my insurance company asking for their criteria for a CPAP. Husband uses a CPAP and loves it, so I am very familiar with them.

Thanks!
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Postby cowlypso » Fri May 06, 2011 2:44 pm

I just had a titration study for cpap this week. On my initial study, I had an AHI of 15, but only one apnea event, the rest (90+) events were hypopnea. I haven't gotten my prescription for the cpap yet, so I haven't actually gotten it authorized by my insurance company. But, the insurance company did pre-authorize the cpap titration study, and it would be silly for them to do that without intending to also pay for the cpap. My official diagnosis is still moderate obstructive sleep apnea, even though I only had one apnea event, because the diagnosis of OSA is based on the AHI. I know that my sleep lab scored the hypopneas on the alternative standard. My oxygen also didn't drop a ton. I think my max was 99 and my min was 92. But even so, if his baseline was 98%, a drop to 94% would still be a 4% desat and qualify under the recommended standard. And clearly, with a minimum sat of 92%, he had desats of more than 4%.
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Postby Mom2sleepyson » Tue May 10, 2011 4:17 pm

Finally, we got some good news! We have approval to at least do a trial run with a CPAP. I will feel better about whatever route is recommended and we eventually decide to take if we have least tried a CPAP first. It will be delivered later this week.
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Do many hypopneas indicate CSAS?

Postby avi123 » Fri Jul 01, 2011 11:39 am

From observing posters PSGs' results on several boards it seems to me that a hi number of hypopneas together with low number of Obstructive apneas indicates a probabilty of having a Central Apnea or Complex Apnea syndrome. For those clinics that distinuish between Obstructive and Central Hypopneas, the decision is much simpler.

From Resmed:

What is complex sleep apnea?

Complex sleep apnea (CompSA) is a form of sleep apnea in which central apneas persist or emerge during attempts to treat obstructive events with a continuous positive airway pressure (CPAP) or bilevel device.


CompSA is characterized by the following:

•The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared
•CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour
•With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA (described below)

A diagnosis of central sleep apnea (CSA) requires all of the following:

•An apnea index > 5
•Central apneas/hypopneas > 50% of total apneas/hypopneas
•Central apneas or hypopneas occurring at least 5 times per hour
•Symptoms of either excessive sleepiness or disrupted sleep

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