Question:
another sleep apnea question

I'm very confused. I read an earlier post regarding sleep apnea where someone had said they were conerned about not using their CPAP mask because it could mess up some of the function tests you take pre-op. Here's my question, or problem. I just went to see my PCP, who is very in favor of this surgery, and asked him to set up a sleep apnea test so I could get this over with before surgery. I am 99% sure I have it and so is he (by my symptoms). Anyway, he recommended that I NOT get the test because having surgery will more than likely cure this. Now, keep in mind, I am still at least 4 months away from surgery. I explained to him that I had read that it was important for the anesthesilogist and hospital to know if I had sleep apnea so they could treat me accordingly. He said just to tell them that my PCP feels as though I do. SO, my big question is, will there be a test I will fail because of whatever the sleep apnea is doing to my body? I know you may not have any answer, but should I push this with my PCP or just wait and see if my surgeon requests it? I'm just trying to get a jump on things. I'm in the insurance approval stage.    — Kathy S. (posted on September 15, 2002)

September 15, 2002
I was diagnosed with severe sleep apnea a year before I had my surgery. I sleep with a CPAP every night. I informed the anesthesiologist before surgery and they kept me on oxygen for twenty-four hours. I cannot think of any test that they gave me that would have been swayed either way because of the apnea. Now I do know that the apnea was a factor in getting the insurance company to approve the procedure. After the surgery when I was able to use my CPAP again, I believe it helped me with my breathing exercises. When I used the incentive spirometer, I was able to push the ball to the top sooner then my roomate could. A good pcp would not have you wait for the study, if he honestly believes you have sleep apnea. My study showed that I stopped breathing 432 times during the night and my oxygen saturation dropped to 69. If I had any heart problems I would surely died in my sleep. I may not need the machine after losing weight, but until then I am sure glad I have it!
   — Sue A.

September 15, 2002
Please have the sleep study done. Sleep apnea is a major, sometimes life threatening disorder. Your surgeon and anestisiologist (sp) need to know if you have it or not and to what degree. If you stop breathing while you are under anestesia you cannot wake up to breathe again. Please do not take this lightly.
   — Teekay80

September 15, 2002
GET TESTED! I had unknown apnea and nearly died after minor knee surgery. Morphine depressed my breathing, they had to give me narcam, the anti narcotic. It was so scary:(<P> WLS was a breeze, they handled my apnea with a higher oxygen flowq setting. I never tolerated the bi pap at a pressure of 17 and their was the possiblity of such a high pressure inflating my intestines and causing a leak. Apnea is NOTHING to ignore so get checked NOW! Find out whatever oither tests your surgeon requires and get them as well, if you can.
   — bob-haller

September 15, 2002
Kathy, PLEASE do get tested. Any doctor can send you for it. Please read the memorial on my dear friend, Ginger Brewster, on the memorial page of this website to see what CAN happen if someone goes into surgery with untreated sleep apnea. It makes me so angry when they tell you its not necessary to get the test because the surgery will most likely cure the problem. While the part about "the surgery will most likely cure the problem" is true, having it not treated, and the surgeon and hospital not taking the necessary precautions regarding close monitoring after your surgery can throw you into respiratory failure, which is what happened to Ginger. What a wasted life, for no good reason!!! Kathy, doing it the way your PCP is recommending is putting your life at very high risk! If your PCP doesn't believe this I encourage you to show him the story on Ginger Brewster. And, NO there is no test that you will fail that will preclude you from the surgery. The worst and BEST thing that can happen is that (a) you are on your CPAP several weeks before your surgery which will strengthen your lungs from whatever damage the sleep apnea has already caused, if any, and (b) the surgeon should request that you go to ICU at least for the first 24 hours after surgery till the anesthesia is out of your system. This is covering all the basis and being safe. I can't imagine why a doctor would put you at such high risk for the surgery, unless its to save the insurance company money. Feel free to e-mail me if you have any more problems, questions, or comments. I'm sorry you are having to fight for something that should be "Standard" for anyone with symptoms of sleep apnea. Best of Luck to you.
   — Hackett

September 16, 2002
I agree with everyone else. Get tested so that you have the diagnosis officially listed in your medical records. You said your PCP won't send you out for a sleep test, but perhaps your surgeon will do so. The only test that could possibly come back low when you receive your pre-operation testing is the ABG test (blood gasses). It could come in low for oxygen (mine did), but I doubt it would prevent you from having the operation. Polysomnograms are expensive and I wonder if that is the reason why your PCP does not want you to have the test. If you don't have the test, I would make sure to inform the doctor and speak in length with your anethesiologist informing him that you and your doctor strongly believe you have sleep apnea, but you were never tested, because he felt this would cure it. You might also tell your nurses, because it is not just during the operation that you may be in danger. Pain medications make sleep apnea worse and you will need to be closely watched when you are first started on them. I believe that is where most of the danger lie instead of during the operation, because during the operation you are breathing on a respirator. My doctor keeps all his sleep apnea patients in ICU the first night as a precaution. I was there for two nights, because I had to be weaned from the respirator.
   — Lisa N M.

September 16, 2002
Kathy, To be blunt, I think your PCP is an idiot!! I have worked in the Sleep Medicine field for 15 years and have performed hundreds of polysomnograms. Anyone with the symptoms of sleep apnea should be tested! For one thing, sleep apnea is a co-morbidity and it would certainly help your approval process if it was documented. Secondly, your WLS surgeon and the anethesiologist need to have proof of this condition so they can act accordingly during and after your surgery to keep you safe. Most patients who have been put on Nasal Cpap for their apnea are put on it in the recovery room to keep them breathing! Please insist on having the sleep test done, your life is worth it!!
   — LLinderman

September 17, 2002
In your question you wrote:,<<Anyway, he recommended that I NOT get the test because having surgery will more than likely cure this.>> I would like to take issue with your doctor on this point. Not all people with sleep apnea are MO. I have lost 146 lbs, STILL have sleep apnea, and use my CPAP machine every night. I may never be cured as two other members of my family (brother & sister) also are on CPAPs. I join the others in saying, "Get Tested"
   — Pamela B.

September 19, 2002
Call your surgeon right away and ask for a perscription for the CPAP. The test can be done in your home. The anesthesia will need to be adjusted for you, as an individual. The idea is to get your lungs, and heart, by the way, in better condition for the surgery. Sometimes we have to take the bull by the horns and question what we know we need. I did..and am on a CPAP before surgery...Good Luck..
   — Cheri P.