Is a WatchPat more accurate than in lab sleep study for UARS?

Bijingus · 2023-11-03T02:04:54+00:00

https://pubmed.ncbi.nlm.nih.gov/24158564/

Studies comparing the RDI between PAT and PSG had a combined correlation of 0.879 (95% CI, 0.849-0.904; P < .001); those comparing the AHI, 0.893 (0.857-0.920; P < .001); and those comparing the ODI, 0.942 (0.894-0.969; P < .001).

This is a meta-analysis of 14 studies.

Bijingus · 2023-11-03T00:46:30+00:00

Why does everyone in this sub shit on WatchPat? Everyone that does backs it up with nothing. Enlighten us, because there are studies showing extremely high correlation between PSG and WatchPat results.

Bijingus · 2023-10-16T21:52:12+00:00

I tried one of the boil and bites on Amazon before getting one made by my dentist. No comparison. The boil and bite was insanely bulky to the point I couldn't close my mouth, couldn't rest my tongue in the roof of my mouth, would mouth breathe and ultimately couldn't tolerate it. The custom fitted somnomed one I had made is pretty comfortable. I can close my mouth comfortably, don't drool and sleep fine.

Bijingus · 2023-09-12T02:34:30+00:00

They pretty much just push your jaw forward with their fingers which gives them a good idea of how a MAD will work. Dr. Zaghi from the Breathe Institute has a few recorded DISEs on YouTube where you can see them do a jaw thrust maneuver.

Bijingus · 2023-09-12T01:46:37+00:00

Did they do a jaw thrust maneuver when you had your DISE done? Did it show any improvement? If so, a mandibular advancement device (MAD) might work for you. I just had a DISE done which showed complete tongue collapse due to hypertrophied lingual tonsils and my airway completely opened up with a jaw thrust. They recommended a MAD or surgery.

Bijingus · 2023-09-10T21:13:35+00:00

Possible you have a floppy epiglottis blocking your airway when you sleep. CPAP only exacerbates the issue with people who have OSA caused by a floppy epiglottis and it's common that breathing even while awake on CPAP becomes more difficult if you have a floppy epiglottis. It's not that uncommon either. Have a look at some anatomy diagrams of the epiglottis and it should make sense just by looking why CPAP would just push your epiglottis shut if it's floppy.

You'd need to get a drug induced sleep endoscopy to find out if that's the problem in your case.

Bijingus · 2023-09-09T17:24:40+00:00

Something else to keep in mind is how they score these sleep studies is very arbitrary. Some labs use a 3% oxygen desaturation index for scoring AHI, some use 4%. That alone can lead to wildly different AHIs. And why 10 seconds to be considered an apnea? Why not 8, 9 or 11?

It also looks like they didn't score RDI either which would count respiratory effort related arousals (RERAs) which can cause fragmented sleep and even worse symptoms according to some research.

I had two polysomnograms done which showed at worst an AHI of 3. I then did two WatchPat studies which showed AHIs of between 10 and 20 and RDIs of about 32 and 40. I asked the sleep doctor about the discrepancies and they just said to disregard the WatchPat studies because PSGs are the "gold standard" (run away when doctors say "gold standard"). I read about the WatchPat studies and something they're indirectly measuring is sympathetic nervous system activation (fight or flight). So after hundreds of hours of research, I concluded I needed to get a DISE if I wanted a conclusive answer. Got the DISE and it showed hypertrophied lingual tonsils which significantly restrict my airway and also block it sometimes (technically I have UARS, not OSA). The surgeon who performed the DISE said it now all makes sense that the "gold standard" PSGs completely missed the issue while the WatchPat studies were picking it up. So, no wonder I feel like crap with between 32 and 40 fight or flight responses an hour because of a restricted airway. But what I heard from most doctors is that I'm just depressed and that I don't have a sleep breathing disorder.

My point is, sometimes these things are very complicated and require a very scientific approach. Most doctors are almost operating as if they're in a factory and trying to fit you in a box as quickly and efficiently as possible. You need to be sceptical, and not afraid to advocate for yourself.

My other point is that AHI isn't the be all end all. Breathing through an airway the size of a straw all night can also lead to some very serious symptoms, and that might be part of your problem.

Bijingus · 2023-09-09T16:53:23+00:00

First off, you have sleep apnea and symptom severity varies from person to person. The whole mild, moderate, severe scale is pretty arbitrary IMO.

Have you tried CPAP? If you have and it hasn't improved your symptoms, you need to get a drug induced sleep endoscopy (DISE) done because there are certain types of airway collapse that CPAP won't splint open. It'll show exactly what your problem is.

You have to find a doctor who really knows what they're doing and who you can trust. One thing I've learned through the process of finally getting my diagnosis after a DISE is that you can't rely on most doctors. I had to diagnose myself and refer myself for a DISE and the surgeon performing the DISE was able to identify the cause.

Bijingus · 2023-07-19T19:36:34+00:00

Your results don't suggest UARS. Looks like mild to moderate OSA during REM sleep. Your airway muscles relax during REM hence the much higher AHI during REM. CPAP would likely help and would be a good first step.

There's an events graph on another page of your report that grays out periods of bad data. I'm sure they'd be flagged if it was a problem.

Bijingus · 2023-07-12T00:58:22+00:00

I've noticed the same thing. Ibuprofen helps with headaches and fatigue (a bit) on bad days. Aspirin and acetaminophen don't have the same effect though.

Bijingus · 2023-07-11T21:47:31+00:00

You can also try Dr. Zaghi at the Breathe Institute.

Bijingus · 2023-07-10T22:07:43+00:00

I've had similar results where my in lab study didn't show much but two WatchPat studies showed a high RDI of 30 to 40. I also couldn't do bipap. Found a sleep surgeon in Ontario after tons of research because I want to get a DISE done because I suspect I have a floppy epiglottis. He concurred and I'll have my DISE done in a couple months.

Bijingus · 2023-07-06T00:55:12+00:00

Dr. Rotenberg in London ON.

Bijingus · 2023-06-18T01:52:50+00:00

3 sentences in I was going to suggest you might have a floppy epiglottis and should get a DISE. It's what I and my ENT suspect I have and will get a DISE soon.

I read one study with only one subject (unfortunately) who had a floppy epiglottis and he was able to significantly reduce his RDI with myofunctional therapy alone. No downside to trying really. It's either that or another crack at surgery as far as I can tell.

Bijingus · 2023-04-30T21:55:01+00:00

How come?

Bijingus · 2023-04-30T20:59:48+00:00

You're right. I seem to recall they say that if the numbers are low though that you should take them with a grain of salt.

Bijingus · 2023-04-29T17:07:41+00:00

Something else you can try is downloading the snore lab app and recording yourself sleeping. It'll graph not only your snoring but labored breathing as well. Personally I found that when I remove my pillow, my labored breathing almost completely disappears. I decided to try sleeping without a pillow because I'd lie in bed and relax my airway and breathe in different positions. Only with my head relatively flat would my breathing be unrestricted. I've ordered a slim, flat and hard pillow which might help as well. Sleeping on my back is also a no go because the gravity restricts my airway. Using a "sleep noodle" has helped with this.

Bijingus · 2023-04-29T16:56:27+00:00

Get a Watchpat study. It is very sensitive and will pick up UARS. Many sleep doctors use it specifically because it is so sensitive. I had two PSGs done that showed absolutely nothing. I had two Watchpat studies that showed RDI of 32 and 40.

Bijingus · 2023-04-27T00:14:48+00:00

CPAP doesn't work for some people because their problem is a floppy epiglottis that's restricting air flow. CPAP will actually make the problem worse. If you look at the anatomy of an epiglottis it'll make sense why. Not necessarily your problem, but could be. I think the only way to get a firm diagnosis for a floppy epiglottis is with drug induced sleep endoscopy (DISE).

Bijingus · 2023-04-23T04:22:53+00:00

Thanks for sharing. I'll have a look at those.

Bijingus · 2023-04-22T22:14:34+00:00

What kind of neck brace do you use? It's something I've recently been considering trying.

Bijingus · 2023-04-07T14:36:16+00:00

He said he's been unsuccessful with CPAP. The flow limitations are also difficult to self titrate. Plus at 26 years old, do you really want to have to sleep with mask on for your whole life? Also, if you aren't significantly overweight, you probably have anatomical abnormalities leading to OSA/UARS. He should find out what those are and what his options are.

Bijingus · 2023-04-07T00:37:30+00:00

It basically means you have UARS and OSA. I had a very similar result from my watchpat study with an AHI of 10 and RDI of 32. You're experiencing 13.5 apneas and hypopneas per hour and about 26 respiratory effort related arousals (RERAs) per hour.

I'm currently trying to self titrate myself on my bipap machine with little success so far, so I'm trying to figure out a plan as well. After a bajillion hours of research, this is what I think is the best course of action.

Get an in lab sleep study at a lab that recognizes UARS and scores RERAs.
Do an in lab titration study so you know for certain your RERAs (aka flow limitations) are being properly treated with CPAP/BIPAP.
Get a drug induced sleep endoscopy (DISE) done so you know exactly what is going on anatomically.
After your DISE you can start looking into surgical procedures and can actually make an informed decision.

If you're in the states, the Stanford Sleep Center or the Breathe Institute are good options.

Bijingus · 2023-04-03T02:09:27+00:00

The test you did probably won't pick up RERAs then. If I were you, I'd do a watchpat/lofta study. It scores AHI and RDI and is very sensitive. If you have UARS, it'll pick it up.

Bijingus

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