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Re: apneas without desaturation

Posted by seattlebill on December 07, 2006 at 10:00:19:

In Reply to: Re: apneas without desaturation posted by sleepy-in-seattle on December 07, 2006 at 09:41:29:

Well...

Several points. Some may enter the discussion of which is better home study vs in-house study.
And, there are good and bad points either way. Clearly a home study is a great screening tool...but, ultimately it is not regarded as a gold standard.

Much depends too on the patient and/or the ultimate goal. An 81 year old with parkinsons and a frontal benign tumor shouldn't have aggressive operative intervention...so a PAP device is probably his destination therapy. He may also have other issues than pure obstruction...perhaps central apneas... I'm not certain how well a home study can discriminate between central apneas and/or obstructive apneas... Either way, a PAP device seems to be his destination therapy.

The patient's BMI is...as we've all seen, indicative of nothing. Small people can have OSA as well as larger people. So that fact is not as relevant as his functional findings on testing.

Bearing all these things in mind, doing a homestudy on CPAP sounds reasonable...but if he fails, or findings are odd...maybe he should go in and get a split night study (no CPAP/CPAP).

He would definitely not be a person to have any procedures on (except for the shortest turbinate reduction...perhaps)...so doing an aggressive work up should only be geared to getting the correct PAP settings and correct device and optimizing non-operative management.

B.



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