info on Apnea & "high blood pressure of the lungs?"

[bbmiller]

I was told by a Pulmonologist that sleep apnea causes high blood pressure of the lungs, but have not been able to find any other source of information on this. Can anybody give me sources of information on the relationship between high blood pressure of the lungs and sleep apnea?

[alnhwrd]

http://www.medicinenet.com/pulmonary_hy ... rticle.htm

[bbmiller]

alnhwrd - thank you for that link.

From the article alnhwrd linked me to wife found out what I am calling "high blood pressure of the lungs" is also called "pulmonary hypertension" and when it is caused by sleep apnea is called "secondary pulmonary hypertension" that is pulmonary hypertension which is caused by a secondary disease. What I would like to find out if possible is what sleep apnea hypoxia index would represent your sleep apnea disease being sufficiently treated to eliminate sleep apnea as a cause of secondary pulmonary hypertension? Have any of you talk about this with your doctors? Or is there some other article I might look at to give me this information?

[jules]

my understanding is pulmonary hypertension is diagnosed based on reading and calculations from an echocardiogram

I suggest you contact a cardiologist for a diagnosis (although they might refer one to a pulmonologist for treatment)

[bbmiller]

My cardiologist has diagnosed a less than perfect repair of my micro valve by an operation as a cause of some stenosis which causes some high blood pressure of the lungs. The pulmonologist I saw to diagnose sleep apnea said this was another cause of high blood pressure of the lungs. My question here is how well that my sleep apnea have to be treated to eliminate sleep apnea as a cause of high blood pressure of the lungs or secondary pulmonary hypertension? Eventually I will see these doctors again but to be forewarned is to be for armed. A link or personal opinion would strong warnings that this is not a doctor's opinion would be fine.

[jules]

I have received a diagnosis of mild PH on a couple from a couple echos however there was an echo in between these two were it wasn't there allegedly.

I do know there was lots of breathing problems that mimicked asthma walking uphills, that were not relieved by inhalers before the first echo. I no longer have that problem and can't recall exactly when that changed but it was also pre-cpap.

All echo's were done prior to cpap treatment so I am afraid I can't help you on your dilemma.

[kteague]

bbmiller - I was looking around over on the PubMed site by searching on 'pulomnary hypertension cpap' and saw lots of articles on the topic, but none that I read gave a formula to predict how long successful CPAP treatment needs to be in place to see improvement of pulmonary hypertension. Hopefully your doctor can determine a reasonable length of time at which to recheck your pressure. With you having two possible contributors (the valve & OSA), let's hope CPAP treatment proves OSA to have been the major player in your PH.

[bbmiller]

kteague - thank you for your efforts. Your search criteria and response was very good food for thought.

From the above response I got the idea to try this Google search - "pulmonary hypertension" cpap apnoea/hypopnoea index

This proved to at least give me articles which "pulmonary hypertension" and apnea/hypoxia index, however I kind of came to the same conclusion as above in kteague's post. It will be very hard to find an article with gives you guidelines as to how low apnea/hypoxia index is necessary to achieve reduced pulmonary hypertension. Consequently my question has changed. I am very new to cpap machine therapy. I am presently loaning a machine from my health plan with a guesstimate from my therapist as to what pressure I require. They will do further checks with the automatic machine they use for this purpose. I plan to buy the best cpap machine possible automatic with exhale relief and anything else I find out maybe necessary or desirable. My question now is if I am a stubborn patient and ask them to change the pressure range of an automatic machine several times and do whatever else they could do. Could this increase the likelihood of achieving a apnea/hypoxia index in the normal range from my therapy? My present index is quite bad without therapy being 83 which comes about from and obstructive apnea index of 66.6 and a hypoxia index of 16.6. I am also presently losing weight. So I'm wondering if there is anything I could do in my control which will increase the chances of my treatment being totally effective and totally reversing my index to normal ranges with this cpap machine therapy?

[brazospearl]

bbmiller, you've come to the right place to find out the best info on current machines, masks, and other equipment for successful therapy for your OSA. What machine are you currently using? What is the "guesstimated" pressure you mentioned? If you can see any data, what is your AI, HI, AHI, & leak rate? What mask are you using? If you fill out your profile with this sort of info, we'll be able to give more specific advice.

When acquiring a machine of your own, you need FULL DATA CAPABILITY (not the same thing as compliance data) as well as autotitrating capability and exhale relief and humidifier. With these components, a clinician's manual, and help from the good people on this forum, YOU can be in charge of tweaking your therapy, and you won't need your dr/DME/RT/whoever to worry their pretty little heads about it. If you want the best possible therapy as soon as possible, you must take the steps to make that happen, including grasping the fact that YOU can make adjustments to your machine.

My guess is that you haven't been able to find guidelines for optimally effective cpap therapy as a means to reduce pulmonary hypertension because there hasn't been a good study done. Logically, it seems that effective therapy won't make that condition worse, but a publishable study just might not be out there yet.

[bbmiller]

brazospearl -thank you for your interest in helping me. I would be particularly interested in how you are using your auto set II have you bought the software?

Well I have filled in what in the profile I understand how to fill in which is my age and location. I do not social network or a message board or do lot of the other things there are space for in your profile. I do not see a space to include the type of message many of you include on the bottom of your posts namely your equipment.

My present equipment is a Remed full face mask Quattro exchangeable with my health plan till September 20.
My present cpap machine is a Remed Esape one on loan from my health plan till September 20.

I do not know what pressure it said on perhaps if somebody knows that machine their could tell me how to find out. I presently only know how to use the start stop button. I was strongly considering purchasing a used "ReMed auto set II" thinking of jumping on getting one Monday morning while I can still get a lightly used one. I was thinking of doing this because that was the only one my health plan uses to get full reports on you and adjust your therapy and my therapist said you can get the mask leakage and Apnea Hypopnea Index right off the top of the machine without software. I was thinking that was the only thing I could understand anyway. Seeing full ReMed reports elsewhere on this site they seem incomprehensible to me. There was another machine I was also considering purchasing "DeVilbiss IntelliPAP AutoAdjust with SMARTFLEX (CFLEX/AFLEX) and Heated Humidifier" with this machine too I was only thinking of buying the machine and using the smart code reporting reports you can get on the Internet without purchasing the software. I could certainly purchase software if it is desirable, but currently find many reports I see on this site too complicated to understand and my health plan therapist will only help me with her own interpretation of the ReMed reports not anything I buy.

[brazospearl]

bb, I completely understand being confused by the data and navigating the settings on this forum! Seriously, I'm lucky to be able to work email...but I can help you here! To show the equipment you're currently using:
Log on to the forum
Look in the upper left corner (not the tippy-top where it says cpaptalk.com, but just underneath "search") and
Click on User Control Panel
then...
Click on Profile (the 2nd tab)
Edit Equipment will be the second heading in the list on the left
It's pretty self-explanatory from there
(I hear all you geek-types laughing and thinking it was easy from the first! It's only easy if you know how!)

If you're going to get a Resmed machine, the S9 is the current top-of-the-line model, and its easier to get the data from it to your computer. I use the S8 Auto, and I just go by the data on the display. (This goes against what many on the forum think is appropriate, but it's working for me right now so what's the problem? Also, I use a Mac, and running the program is trickier than I care to deal with right now...)

At least one of our members has the latest DeVillbiss and is enthusiastic about it. There is also an excellent PR System 1 Auto (is that the name?) that is top of the line. Run the numbers to figure out the best deal, including what (if anything) your insurance will cover and how it would be billed if you went through your local DME. Many times it's less money out of pocket to purchase online, even if you aren't reimbursed. Some other important points: You must get the prescription in your hand, none of this "we'll send it to the DME for you" nonsense. It's important that you have it so you know exactly what it says. If the doctor objects, remind him that you need it in case you're traveling and have to buy supplies when you're out of town. That's the truth, and it is also your legal right to have the prescription given to you. You also need a copy of your sleep study records; again, it's your legal right to have this. It's also your legal right to purchase your supplies anywhere you choose.

There's lots to learn about apnea and its treatment, and you've got plenty at stake. Keep reading here, keep asking questions; we're here to help.

[Janknitz]

So I'm wondering if there is anything I could do in my control which will increase the chances of my treatment being totally effective and totally reversing my index to normal ranges with this cpap machine therapy?

Absolutely!

As Brazospearl already pointed out, you need the auto machine you can afford with full data capability. Secondly, you need a mask that is comfortable enough to wear all night, every night without excessive leaking or discomfort, and thirdly, you need to keep up the good attitude.

If you want to "reverse your index to normal ranges" you must use your CPAP every time you sleep for the entire time you sleep. That is the key to giving yourself the best chance of reducing the pulmonary hypertension.

With data, you can see if your therapy is effective and problem-solve issues that may impair the efficacy (i.e. leaks, incorrect pressures, etc.). It's a steep learning curve, but you need to make an effort to learn about the data and what all of those reports mean, so that you can take an active role in your therapy. It's really not rocket science--if you look at one chart at a time you can see if you are leaking, what your pressures are, etc. That way if you are having a problem, you can spot the issue and discuss it with your doctor proactively, instead of waiting until your next follow-up and hoping the doctor will notice it.

I have a data tutorial for the Resperonice (PR System One) data here http://maskarrayed.wordpress.com/2010/0 ... -tutorial/and I tried to break it down into managable bits to help people understand what they are seeing. The charts look a little different than Resmed charts, but it's really the same stuff.

[bbmiller]

As Brazospearl already pointed out, need the auto machine you can afford with full data capability. Secondly, you need a mask that is comfortable enough to wear all night, every night without excessive leaking or discomfort, and thirdly, you need to keep up the good attitude.

I have a data tutorial for the Resperonice (PR System One) data here http://maskarrayed.wordpress.com/2010/0 ... -tutorial/ and I tried to break it down into managable bits to help people understand what they are seeing. The charts look a little different than Resmed charts, but it's really the same stuff. .

Forgive me for asking further questions before I had time to look at let alone digest Janknitz tutorial. But as I am going to speak to my respiratory therapist tomorrow morning during a scheduled telephone appointment time is of the essence. At the risk of repeating myself it is my health plans way to loan you their auto set II Resmed cpap machine and use its report to make adjustments in your therapy. In regard to getting the auto machine I could afford I have just lost out on getting a low usage ResMed auto set II use machine I could afford and am awaiting another opportunity to buy one of these. Consequently I am wondering what data capable should mean and what would be the consequences of me looking at another songbook (different report that my therapist) when looking at the results of the report data capable cpap machine. Also wondering if it truly data capable machine is just the two brands Resperonice and ResMed since these brands appear to give you a minute by minute report of your nights sleep? In regard to Resperonice CPAP machines could anyone look at this list of available CPAP machines and tell me which use one's may be sufficiently capable to be very proactive in your therapy provided you buy the software?

Respironics

Gently Used Respironics M Series DS100 CPAP $150

Gently Used Respironics Legacy REMstar Plus CPAP $150

Gently Used Respironics M Series DS200 CPAP w/ CFLEX $199

Gently Used Respironics M Series DS400 CPAP w/ CFLEX $225

Gently Used Respironics M Series DS510 Auto CPAP w/ AFLEX $349

Gently Used Respironics System One DS450HS CPAP w/ CFLEX with Htd Humidifier $425

Gently Used Respironics System One DS550HS CPAP w/ AFLEX with Htd Humidifier $479

Gently Used Respironics System One DS750HS BIPAP AUTO with Htd Humidifier $799

Gently Used Respironics BIPAP M Series DS600 BIPAP Plus w/ Htd. Humidifier $645

Gently Used Respironics BIPAP M Series DS700 BIPAP Plus w/ Htd. Humidifier $699

Gently Used Respironics BIPAP ST & Heated Humidifier w/ Back up Rate $825

Gently Used Respironics BIPAP Auto SV & Heated Humidifier w/ Back up Rate $899

New Factory Sealed Respironics REMstar DS200 CPAP with CFLEX $275

As seen at the http://www.secondwindcpap.com/ site.


Another question is a full list of all the parameters that are at play to adjust a sleep with a cpap machine is one a change in the pressure range allowed with a automatic machine, that does not change during the night, two adjusting the mask for low leakage and three the respiratory relief setting? Or are there other things that can be controlled as well?