CPAPtalk.com

Much obliged for your continuing research.

bailachel wrote:please post the link.

Sure.

http://www.in-isrc.org/docs/081013.Upsa ... PinSDB.pdf

Muffy

BleepingBeauty wrote:Why not just post the link, so everyone can read it?

dsm wrote:Hi y'all
I originally posted the link but thought better of it. The document is on my own website not the originators & I am becoming increasingly concerned about copyright issues. If it was a matter of a link to his site I would happily post that, but because it is on mine, there may be issues to do with usage.

Speaking of copyright issues, dsm: Each an everyone of images you copied from the presentation is linked to your own site. This is an example, to help you avoid that copyright infringement problem:

dsm wrote:I have a presentation on OSA done by Shahid M. Ahsan, M.D of the Sigma Medical Group.
Below are a few of the charts in it. They are reasonably current & the info very useful.

DSM

Code: Select all

[img]http://www.internetage.ws/cpapdata/images/osa-chart-1.jpg[/img]

[img]http://www.internetage.ws/cpapdata/images/osa-chart-2.jpg[/img]

[img]http://www.internetage.ws/cpapdata/images/osa-chart-2a.jpg[/img]

[img]http://www.internetage.ws/cpapdata/images/osa-chart-2b.jpg[/img]

[img]http://www.internetage.ws/cpapdata/images/osa-chart-2c.jpg[/img]

[img]http://www.internetage.ws/cpapdata/images/osa-chart-2d.jpg[/img]

Muffy wrote:

bailachel wrote:please post the link.

Sure.

http://www.in-isrc.org/docs/081013.Upsa ... PinSDB.pdf

Muffy

Much obliged for your continuing research, Muffy.

O.

Muffy wrote:

bailachel wrote:please post the link.

Sure.

http://www.in-isrc.org/docs/081013.Upsa ... PinSDB.pdf

Muffy

Thanks

That solved the problem !. I had downloaded it sometime in 2009 (or earlier) & could not recall where from.
Now we know.

DSM

It is worth noting that the doc who prepared these charts made a few mistakes (slip ups) & when I posted the initial images I left some charts out for that reason.

The 1st & most obvious mistake is that in slide 4 titled 'SLEEP APNEA' the doc wrote the definitions for
Mixed Apnea & CompSA back to front. An embarrassing slip up & one that still shows in the linked to original.

DSM

dsm wrote: The 1st & most obvious mistake is that in slide 4 titled 'SLEEP APNEA' the doc wrote the definitions for
Mixed Apnea & CompSA back to front. An embarrassing slip up & one that still shows in the linked to original.
DSM

Not on my version of slide 4, Here's what my version shows (from Muffy's link http://www.in-isrc.org/docs/081013.Upsa ... PinSDB.pdf) :

• Obstructive apnea: ventilatory effort but no airflow
  Central apnea: no effort to breathing
  Mixed apnea: no ventilatory effort, but an obstructive apnea
  pattern is evident when effort resumes
  Complex Sleep Apnea have a mixture of both OSA and CSA

According the American Academy of Sleep Medicine

"Score a respiratory event as a mixed apnea if it meets apnea criteria and is associated with absent inspiratory effort in the initial portion of the event, followed by resumption of inspiratory effort in the second portion of the event."

see table 3 here: http://www.aasmnet.org/Resources/Practi ... graphy.pdf

Nothing back to front in Dr. Ahsan's definitions as seen in the original.

Comlex sleep apnea is discused further on page 55 and onwards.

I would suggest nobody send the presentation to anyone before viewing all of it -that picture of a sore caused the mask (page 19) can be a detrant for those who don't want to admit they need cpap therapy.

O.

Hi Ozij & thanks for your analytical input

Yes you are right ! in that presentation which says "Complex Sleep Apnea have a mixture of both OSA and CSA" - perhaps this is a matter of interpretation ?

I had read this which prompted me to see CompSA as OSA converting to Central Apnea ...

"Complex sleep apnea has recently been described by researchers as a novel presentation of sleep apnea. Patients with complex sleep apnea exhibit OSA, but upon application of positive airway pressure the patient exhibits persistent central sleep apnea. This central apnea is most commonly noted while on CPAP therapy after the obstructive component has been eliminated. This has long been seen in sleep laboratories and has historically been managed either by CPAP or BiLevel therapy. Adaptive servo-ventilation (ASV) modes of therapy have been introduced to attempt to manage this complex sleep apnea. Studies have demonstrated marginally superior performance of the adaptive servo ventilators in treating Cheyne-Stokes breathing; however, no longitudinal studies have yet been published, nor have any results been generated that suggest any differential outcomes versus standard CPAP therapy. At the AARC 2006 in Las Vegas, NV, researchers reported successful treatment of hundreds of patients on ASV therapy; however, these results have not been reported in peer-reviewed publications as of July 2007[update]."

Also, here is a typical summary of the term Mixed Apnea "Mixed apnea is the term used when central and obstructive sleep apneas occur together."

This is clearly an unclear topic !.

Cheers & thanks

DSM

#2
Resmed web site ...
http://www.resmed.com/us/clinicians/abo ... clinicians

As follows ...

What is complex sleep apnea?
Complex sleep apnea (CompSA) is a form of sleep apnea in which central apneas persist or emerge during attempts to treat obstructive events with a continuous positive airway pressure (CPAP) or bilevel device.

CompSA is characterized by the following:

* The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared
* CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour
* With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA (described below)



A diagnosis of central sleep apnea (CSA) requires all of the following:

* An apnea index > 5
* Central apneas/hypopneas > 50% of total apneas/hypopneas
* Central apneas or hypopneas occurring at least 5 times per hour
* Symptoms of either excessive sleepiness or disrupted sleep

The difference between central, mixed and complex sleep apnea
CSA is a form of sleep-disordered breathing (SDB) caused by the temporary absence of a signal from the brain’s respiratory center. Without this signal, there is no effort to breathe. Mixed sleep apnea is fairly common and consists of both central and obstructive components. On the other hand, CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices.


The challenge to treat CompSA
Patients with CompSA cannot be adequately treated with CPAP or bilevel device. The clinical consequences are residual symptoms (fatigue, sleepiness, depressed mood) and intolerance to therapy.


Patients with CompSA may be seen as those who cannot tolerate conventional CPAP or bilevel therapy both during lab titration and at home. Neither CPAP nor bilevel therapy seems to alleviate their sleep disorders. For CompSA patients, treatment with CPAP or bilevel therapy will leave them with a somewhat elevated AHI, and their disorder will not be completely resolved.


How does the VPAP Adapt SV treat CompSA?

Our VPAP Adapt SV is the first FDA-cleared device designed to treat CSA, CompSA, mixed apnea and periodic breathing. VPAP Adapt SV uses adaptive servo-ventilation to adapt to a patient’s ventilatory needs on a breath-by-breath basis.

**************************************************************************************************************************

I come back to my original point that the above seems to be in contrast to the original presntation ?

Thanks

D

Your orignial point:

dsm wrote: The 1st & most obvious mistake is that in slide 4 titled 'SLEEP APNEA' the doc wrote the definitions for
Mixed Apnea & CompSA back to front. An embarrassing slip up & one that still shows in the linked to original.
DSM

The text in slide 4:

• Obstructive apnea: ventilatory effort but no airflow
  Central apnea: no effort to breathing
  Mixed apnea: no ventilatory effort, but an obstructive apnea
  pattern is evident when effort resumes
  Complex Sleep Apnea have a mixture of both OSA and CSA

I fail to see how the quotes from ResMed support your original point.

O.

ozij wrote:Your orignial point:

dsm wrote: The 1st & most obvious mistake is that in slide 4 titled 'SLEEP APNEA' the doc wrote the definitions for
Mixed Apnea & CompSA back to front. An embarrassing slip up & one that still shows in the linked to original.
DSM

The text in slide 4:

• Obstructive apnea: ventilatory effort but no airflow
  Central apnea: no effort to breathing
  Mixed apnea: no ventilatory effort, but an obstructive apnea
  pattern is evident when effort resumes
  Complex Sleep Apnea have a mixture of both OSA and CSA

I fail to see how the quotes from ResMed support your original point.

O.

Ozij

I fail to see how you can't see that this line contradicts Resmed's point ?
"Complex Sleep Apnea have a mixture of both OSA and CSA"

The definitions I read can be summed up in these words Mixed Apnea is a mixture of OSA & CSA
So when I see that quoted line above, I see a clear summary for Mixed Apnea.

The safe way to summarize CompSA is CompSA is when OSA becomes CSA when cpap pressure is applied !

Cheers

DSM

Your orignial point:

dsm wrote: The 1st & most obvious mistake is that in slide 4 titled 'SLEEP APNEA' the doc wrote the definitions for
Mixed Apnea & CompSA back to front. An embarrassing slip up & one that still shows in the linked to original.
DSM

The text in slide 4:

• Obstructive apnea: ventilatory effort but no airflow
  Mixed apnea: no ventilatory effort, but an obstructive apnea
  pattern is evident when effort resumes

Definition of a mixed apnea by the American Academy of Sleep Medicine

"Score a respiratory event as a mixed apnea if it meets apnea criteria and is associated with absent inspiratory effort in the initial portion of the event, followed by resumption of inspiratory effort in the second portion of the event."

Lol!

A dealock

DSM

dsm wrote:Lol!

A dealock

DSM

Perhaps in your mind there's a deadlock. Not in mine.

ozij's comments make sense to me.

Yes of course they do because Ozij is not responding to my point & yes her perspective is fine
It was painfully obvious to anyone who looked at the rest of the preo that the good Dr had the definitions right in the later slides. Just that one little slip up in wording as stated here ...

"Complex Sleep Apnea have a mixture of both OSA and CSA"

The definitions I read can be summed up in these words Mixed Apnea is a mixture of OSA & CSA
So when I see that quoted line above, I see a clear summary for Mixed Apnea.


So if that was accurate to you - good for you

DSM



DSM

dsm wrote:The definitions I read can be summed up in these words Mixed Apnea is a mixture of OSA & CSA
So when I see that quoted line above, I see a clear summary for Mixed Apnea.

dsm, I have a problem (as I've had many a time in the past) with the way you attempt to sum up things.

I think you may be confusing the definition of a term -- Mixed apnea -- with Dr. Ahsan's use of a word -- mixture -- when he mentions Complex Sleep Apnea as a fourth item on that list.

As I understand it (I could be wrong)...

A Mixed Apnea is a single event that has both central and obstructive components within that one apneic episode. It's a single apnea that starts out as a central (no ventilatory effort) but becomes obstructive when an unsuccessful effort to breathe begins. Mixed apneas can show up in the diagnostic part of a PSG sleep study. Mixed apneas do not mean a person has Complex Sleep Apnea.

Dr. Ahsan had already defined:
Obstructive apnea
Central apnea
Mixed apnea

Given that in his list he had already defined those items (briefly, as befits a short bulleted list) I think his fourth item (that you take issue with) is clear enough:

"Complex Sleep Apnea have a mixture of both OSA and CSA"
(colored emphasis mine)

Farther along (page 55) in the presentation, Dr. Ahsan offers a more elaborate explanation of Complex Sleep Apnea.
The word "mixture" is still used:

rested gal wrote:... As I understand it (I could be wrong)...

A Mixed Apnea is a single event that has both central and obstructive components within that one apneic episode. It's a single apnea that starts out as a central (no ventilatory effort) but becomes obstructive when an unsuccessful effort to breathe begins. Mixed apneas can show up in the diagnostic part of a PSG sleep study. Mixed apneas do not mean a person has Complex Sleep Apnea. ...

Rested Gal, that's exactly how I understand it. And I did ask my sleep specialist.

I will use my own case as an example. I had an apnea index rate that consisted of several obstructive events, one mixed apnea, and many central apneas. In fact there were six times as many central apneas as obstructive apneas. Now, if I had ComplexSAS, my central events would tend to INCREASE as the pressure increases. In fact that was not the case. The central events were pretty evenly distributed. No matter the pressure they were present. In fact, even with the Respironics BiPAP AutoSV unit my prescription used the very top pressure to allow it to help clear my events. No need to limit the pressure.

So, while I have a mixture of events, I do not have ComplexSAS. (Thank goodness. I don't need to handle yet another issue!!)

ComplexSAS includes a mixture of events, but only appears as pressure (therapy) is applied. My central and mixed events exist with or without the pressure.