No one answered this. I am serious. Is this possible Kent or do I need to retest her. Or do sleep labs gouge patients.
Guy W. Moorman, Jr., D.D.S.
The Swamp
Douglas, GA 31533
912-384-7400
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From: acesthetics@googlegroups.com [mailto:acesthetics@googlegroups.com] On Behalf Of Guy Moorman
Sent: Friday, April 26, 2013 11:02 AM
To: 'Kent Smith'; Acesthetics@googlegroups.com
Subject: [ACEsthetics] What happened here
This patient was referred to me by her dentist here in town. She was totally CPAP intolerant and snored horribly. As I told Kent in Dallas, though I say I do not treat sleep apnea I actually mean I do not diagnose it and bypass the CPAP. This lady signed a CPAP intolerance form even though I told her I was treating her for snoring only.
Money was an issue so rather than a Somnodent MAD I made her a TAP 3 Elite. I always do an ambulatory test with the appliance in to see if she shows any improvement or stays the same, in which case I would send her back to the sleep doc for another shot at a CPAP. This lady said she would just have to die before she wore one of those damned things.
The Doctor’s Lab test was done four weeks before the ambulatory test. She was diagnosed with severe apnea so I was very nervous about dealing with her but her husband said he was paying cash because the snoring had to go. I contacted her regular physician and discussed it with her and she told me that anything was better than nothing so if I could do something to help her she would back me up.
Doctor’s lab show REM AHI at 80+ and supine AHI at 40+. It shows frequent desats to 80%. It simply diagnosed severe apnea.
The ambulatory with the TAP 3 Elite in place shows a mean AHI of 3 with 6.5 hours of quality sleep. It appears that her desaturation rate was never below 90% and the mean blood oxygen was 96.5%. This was verified by a pulse oxometer that she wore that her physician provided us. I am considering buying one just to verify the test. With the TAP 3 in place she has very mild apnea to be monitored with significant snoring. Her husband did not notice the snoring because he was already asleep when the first snoring started.
This is a massive change in the degree of obstruction/apnea with a TAP 3 Elite. Does this kind of change occur? I’ve never seen this big a change. I’ve gone from an AHI of 40+ to a 9 and a 20 to a 5 that I can remember but this patient went from severe sleep apnea to actually have not obstructive apnea at all if you classify apnea beginning at 5. The other differences were also troubling to me, especially the blood oxygen desaturation. They are still calling her trying to sell her a CPAP. She told them last time she had one that worked and they should have tried that one a long time ago. I did not prompt that. She is just angry that no one mentioned this in the physician’s office. Opinions? Guy
Guy W. Moorman, Jr., D.D.S.
The Swamp
Douglas, GA 31533
912-384-7400
This email message and any attached files are confidential and are intended solely for the use of the addressee(s) named above. This communication may contain material protected by patient rights, work product, or other privileges. If you are not an intended recipient, you have received this communication in error and any review, use, dissemination, forwarding, printing, copying, or other distribution of this email message and any attached files is strictly prohibited. If you have received the confidential message in error, please notify the sender immediately by reply email message and permanently delete the original message.
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