Contraindication : AutoPAP at High Altitude

[Todzo]

Contraindication : AutoPAP at High Altitude

[Note: if you live at low altitude then go to high altitude I believe the effects and contraindications mentioned in the study would be accentuated. Many experiments regarding the cause of OSA are done at high altitude.]

BRIEF SUMMARY
Current Knowledge/Study Rationale: This study indicates that altitude associated central apneas increase exponentially with increasing
altitude affecting the results attained from diagnostic polysomnography
and leading to increasing difficulty with PAP titrations for OSA. ...
Study Impact: The higher frequency of central apnea at altitudes above 6000 ft. indicates that such altitudes may be a .. contraindication
for the routine use of … automatic
technologies that are unable to clearly differentiate between central and
obstructive apneas. The difficulty of treating OSA due to central apneas
occurring on treatment with PAP at altitude is likely to lead to a higher
level of untreated OSA among these patients.

Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227706/

[big_dave]

The article you referenced does not say anything about the use of AutoPAP machines at high altitude. It talks about difficulties with in-lab titration caused by centrals increasing with altitude. It also suggests that some patients (in the minority) who can be successfully treated at low altitude with "noninvasive PAP" (not AutoPAP) may need to use an ASV machine at high altitude.

The article suggests to me that if travelling to a high altitude, you should keep an eye on your AHI and your detailed graphs in case you develop centrals, regardless of whether you use AutoPAP or fixed-pressure CPAP.

[Todzo]

The article you referenced does not say anything about the use of AutoPAP machines at high altitude. It talks about difficulties with in-lab titration caused by centrals increasing with altitude. It also suggests that some patients (in the minority) who can be successfully treated at low altitude with "noninvasive PAP" (not AutoPAP) may need to use an ASV machine at high altitude.

The article suggests to me that if travelling to a high altitude, you should keep an eye on your AHI and your detailed graphs in case you develop centrals, regardless of whether you use AutoPAP or fixed-pressure CPAP.

"automatic technologies that are unable to clearly differentiate between central and obstructive apneas"

[big_dave]

The article says:

"The higher frequency of central apneas at altitudes above 1800 meters (6000 ft.) indicates that such altitudes may be a relative contraindication for the use of limited channel OSA screening devices and automatic technologies that are unable to clearly differentiate between central and obstructive apneas.

The contraindication is for the use of AutoPAP for titration. I believe that the contraindication would also apply to in-home sleep studies. It does not refer to the use of AutoPAP's by patients who have already been diagnosed.

I'm sorry I missed the quote you cited. It is only a minor part of an article focused on titration.

[Todzo]

Many AutoPAP users here often post symptoms of CO2 maintenance problems which are strongly associated with PAP induced hypocapnic central apneas. I am concerned for them.

I know that my own threshold for CO2 maintenance issues is strongly affected by stress. A couple of months ago I would see signs of unstable breathing in my data at 13 cm/h2o. The anniversary of an assault and robbery upon my person has dropped this below the 8 cm/h2o which still keeps AHI away now. Stress, I believe, has a great deal to do with the threshold at which PAP will induce unstable breathing and hypocapnic central apnea.

For someone under the stress of job or family emergency traveling to that job or emergency, who lives at low altitude but is traveling to high altitude I would think the danger great.

I simply want to make people aware of the issue of stress, altitude, OSA and PAP treatment. I would rather not be responsible for their harm.

[big_dave]

It would be helpful if you could post a summary of what you mean by "C02 maintenance," and what you look for in your data to avoid this problem. I noticed that you have posted about it several times in the past, but your previous posts are rather lengthy. Links to your previous posts may be helpful.

[zoocrewphoto]

I live in Seattle, pretty darned close to the water. On a hill that is about an altitude of 300 feet.

I did a 10 day vacation to Moab, Utah, which is at 4,000 feet. I had no problems at all. Great ahi every night.

I think I have only had one night above 5 since I started April 30 of this year. And most nights, it is below 2.

[Todzo]

I live in Seattle, pretty darned close to the water. On a hill that is about an altitude of 300 feet.

I did a 10 day vacation to Moab, Utah, which is at 4,000 feet. I had no problems at all. Great ahi every night.

I think I have only had one night above 5 since I started April 30 of this year. And most nights, it is below 2.

How was your stress level?

[Todzo]

It would be helpful if you could post a summary of what you mean by "C02 maintenance," and what you look for in your data to avoid this problem. I noticed that you have posted about it several times in the past, but your previous posts are rather lengthy. Links to your previous posts may be helpful.

I would love to.

But i am not up to that right now.

In a nut shell breathing control issues make you blow off too much carbon dioxide which causes physiological changes which damage cells and also appear to tend you toward blowing off more carbon dioxide. PAP pressure is a breathing control issue due to the constant pressure (the equivalent of making the drive to the muscles stronger or the muscles themselves stronger).

Google Scolar: PubMed Search:

Sleep Apnea CO2 reserve
Central Sleep Apnea
Hypocapnic Central Apnea
Sleep Apnea unstable breathing
Sleep Apnea altitude

for details -

- good hunting!

Todzo

[nanwilson]

Todzo
I have read and reread several of your threads and still can't understand a thing you say. I'm beginning to wonder if you are indeed a patient or are you just pulling our chain so to speak. You seem to really enjoy posting a reply to every post that is made...me thinks you just like to see your jumbled up words in print and get a real good giggle at the scam I think you are pulling of the patients here (IMHO). I am really beginning to agree with DeltaDave, he is a professional in the field of sleep apnea.....as opposed to you ??????????????
Cheers and a merry christmas to you.......
Nan

[Lizistired]

I think Todzo has been watching those Buteyko videos.

[Todzo]

simply - the blood is not on my hands

[ems]

simply - the blood is not on my hands

When you say something like you just said, people who might have previously been giving you the benefit of the doubt no longer will. That was so childish and more proof you don't know what you are talking about.

[zoocrewphoto]

Todzo
I have read and reread several of your threads and still can't understand a thing you say. I'm beginning to wonder if you are indeed a patient or are you just pulling our chain so to speak. You seem to really enjoy posting a reply to every post that is made...me thinks you just like to see your jumbled up words in print and get a real good giggle at the scam I think you are pulling of the patients here (IMHO). I am really beginning to agree with DeltaDave, he is a professional in the field of sleep apnea.....as opposed to you ??????????????
Cheers and a merry christmas to you.......
Nan

Me too. I have never understood any of the stuff about CO2, unstable breathing, overbreathing, etc. My machine does well, and I feel better, so I don't worry about it.

But I have wondered if Todzo is really a sleep apnea patient, or somebody trying to do marketing research, or just messing with us.

[big_dave]

simply - the blood is not on my hands

The sky is falling! The sky is falling!