Central sleep apnea?

[Kristy5550]

I have OSA plus CSA. I was wondering how many of you also have central sleep apnea? I am really unsure what the treatment is for CSA.
My sleep Dr. up and left town so I can't ask him.
Thanks for your help.

[Titrator]

Hi Kristy,

It is common to have both Obstructive Sleep Apnea as well as Central Sleep Apnea. Central Sleep Apnea is when your brain forgets to tell your lungs to breath. There isn't the respiratory effort that you see with OSA. With OSA, your body is trying to breath but there is an obstuction, so it can't.

The treatment for both CSA can be treated in several ways. Usually a Spontanious Bi-Level machine is used. If the patient is still having CSA when using a Bi-Level, then you would be prescribed a Timed Bi-Level that has a back-up respiratory rate. This will initiate the inhalation cycle so your body will start to react.

So, you may be treated with CPAP, Spontaneous Bi-Level or Timed Bi-level. Your sleep study will dictate which machine works best for you.

Regards,

Ted

[jammin]

Hi Kristy,

I was diagnosed with a severe case of OSA plus CSA a couple of months ago. Based on posts I've read by ChristineQuilts and others, I requested and got a study on the Resmed VPAP Adapt SV machine. I've been on the machine for six weeks now and saw my sleep doc today. She said the machine had brought all my numbers back to normal, and was very optimistic about treatment. Also, this machine was the first of only two that have been approved by the FDA for treatment of central apnea. There is a very long and ongoing discussion of central apnea and this machine in the message board under the heading of "Resmed VPAP Adapt SV - for Central Sleep Apnea." I found a lot of helpful information there. Good Luck!

[christinequilts]

It is common to have both Obstructive Sleep Apnea as well as Central Sleep Apnea. Central Sleep Apnea is when your brain forgets to tell your lungs to breath. There isn't the respiratory effort that you see with OSA. With OSA, your body is trying to breath but there is an obstuction, so it can't.

Ted, I'm going to argue with you on that point a little. All too often I've seen people who have been Dx'd with OSA who also have some central apneas, which is common, state they have both OSA & CSA, which is not so common. Each has specific diagnostic criteria that must be met to be diagnosed with both; there is a difference in having some central apnea and having CSA. In my case, I'm the reverse with severe CSA (60+ AHI on original study), but I also had an obstructive apnea AHI of 2-3, but never enough to be diagnosed with OSA too, just a normal, healthy number of obstructive events.

It is important for people to figure out were they are at on the continuum- do they have some centrals apneas along with their OSA, or do they have CSA + OSA? Do the central apnea only appear when xPAP pressure was added or did they totally go away as soon the obstructive component was successfully titrated? If they have significant central events, then you want to question why they are happening- there can be a multitude of causes, from an exaggeration in normal breathing variation to a symptoms of other problems to a problem of their own right. Not all central events are created equal.

Central apneas that appear during titration can indicate CompSA/CSDB (Complex Sleep Disordered Breathing or Complex Sleep Apnea) may potentially be a problem. Of course it could also indicate you had a an overzealous titration too, as we've seen from time to time on the boards. Or it could be your body just saying 'hey, this air blowing at me is really weird & is playing tricks on my mind' that might go away within the initial xPAP adaptation period, as this recent indicated:

The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies
Abstract

Objective: To determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy.

Design: Cross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG).

Patients and methods: Forty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients.

Results: Demographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study.

Conclusions: CSA events occurring during CPAP titration are transient and self limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP related CSA.
Chest, May 2007

So for Kristy5550, the first thing you need to do is get your hand on your study results & see what they indicate. If it looks like they are potentially a major problem, then you will need to find a new sleep doctor to explore treatment options. I'm in the minority with pure CSA and no OSA, so a lot of things that might work for you were not an option for me. Plus things are changing every year as far as treatment of centrals- what we had 4 years ago seems archaic to me now that I'm on a VPAP Adapt finally, but even that still left me a double digit residual AHI.

jammin- glad to here you are still doing well with your Adapt. Its a wonderful machine for those of us who need it, though I do question how some of its functions & tendencies would affect a more typical straight OSA person. Which mask are you using with your Adapt?

[dieselgal]

In a sleep study how do they know if you have a central apnea? What tells them what made you stop breathing?

[christinequilts]

In a sleep study how do they know if you have a central apnea? What tells them what made you stop breathing?

Remember the straps around your chest & abdomen? During an obstructive event, those are moving as you struggle to breath but can't; but during a central, there is no movement. They also use a transducer near your nose & mouth that kind of looks like an O2 nasal thing. That is sensing if there is any air movement at all, because with an obstructive, there is usually a little, but not with a central. There are other things they can look at too to help figure out which is which, and it does come down to clinical judgment. And in all reality, its much easier for an obstructive event to be mislabeled a central if they are being cautious, then for a central to be labeled an obstructive.

[jammin]

Hi Christinequilts,

I tried the Ultra Mirage Full Face mask for a couple of weeks but it leaked a lot and did so noisily, then purchased a Swift II which is very comfortable for me, but it, too, leaks a bit at times and as we've discussed, it doesn't pass the learn circuit test. Last week I bought a Vista on ebay, noting that it worked well for you. When I finally got it to stop leaking it gave me a pressure sore after two nights, but aside from that I did think the adapt was happier with it and the UMFF. When I told my doc about all this yesterday she said she was going to call the DME right away and insist that they provide me some different masks to try out, and that I shouldn't settle for anything that didn't provide comfort, quietness and a good seal. That may be a tall order given the things I read here, and if we stay within the Resmed approved masks there really aren't many choices left.

The weirdest thing about my case is that I've never really had any daytime symptoms resulting from apnea. My PSG results are awful, and I have had arrythmias at times that are most likely correlated to the sleep apnea, but never daytime drowsiness, unless you can call the 3PM lull most of us have as a related problem. The doc can't quite understand why I don't feel better on treatment, but I didn't feel badly to start with. I'm cooperating with the treatment mainly to avoid future complications, which I think did my father in, as he was almost certainly apneic. He died at 74, a severe diabetic with a damaged heart and a series of strokes.

[christinequilts]

At first I was open to using non-approved masks that could at least pass LC on there own, but after the Swift incident, I can detect a small difference in how the machine acts versus when I use my Vista or Activa, so I would make sure you rule out a ResMed approved mask at all cost before considering others, personally. Have you given an Activa a try yet? That's my backup...its just with my skin sensitivity to physical pressure & getting hives/welts, I have to be very careful about the bridge of my nose, so I can't use it full time. If it wasn't for that, I would. I know the Vista is not the easiest mask- it had the longest learning curve of any mask I've used, but for me, it was worth it. Also, the new FFM from ResMed should be okay too, and is suppose to be better then the UMFF.

But yeah, I have a full compliment of all compatible mask. I think for the price of the machine, they should come along as an included accessory pack for starters. Sometimes just being able to rotate through masks can help, though its a bigger PIA when you have to run LC...especially at 2am I'll try to post some pointers on the Vista I wish I would have known early on to see if that helps latter tonight, if I get chance. I'm headed out of town for a wedding this weekend and it seems everything that can go wrong is...

[Snoredog]

It is common to have both Obstructive Sleep Apnea as well as Central Sleep Apnea. Central Sleep Apnea is when your brain forgets to tell your lungs to breath. There isn't the respiratory effort that you see with OSA. With OSA, your body is trying to breath but there is an obstuction, so it can't.

Ted, I'm going to argue with you on that point a little. All too often I've seen people who have been Dx'd with OSA who also have some central apneas, which is common, state they have both OSA & CSA, which is not so common. Each has specific diagnostic criteria that must be met to be diagnosed with both; there is a difference in having some central apnea and having CSA. In my case, I'm the reverse with severe CSA (60+ AHI on original study), but I also had an obstructive apnea AHI of 2-3, but never enough to be diagnosed with OSA too, just a normal, healthy number of obstructive events.

It is important for people to figure out were they are at on the continuum- do they have some centrals apneas along with their OSA, or do they have CSA + OSA? Do the central apnea only appear when xPAP pressure was added or did they totally go away as soon the obstructive component was successfully titrated? If they have significant central events, then you want to question why they are happening- there can be a multitude of causes, from an exaggeration in normal breathing variation to a symptoms of other problems to a problem of their own right. Not all central events are created equal.

Central apneas that appear during titration can indicate CompSA/CSDB (Complex Sleep Disordered Breathing or Complex Sleep Apnea) may potentially be a problem. Of course it could also indicate you had a an overzealous titration too, as we've seen from time to time on the boards. Or it could be your body just saying 'hey, this air blowing at me is really weird & is playing tricks on my mind' that might go away within the initial xPAP adaptation period, as this recent indicated:

The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies
Abstract

Objective: To determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy.

Design: Cross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG).

Patients and methods: Forty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients.

Results: Demographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study.

Conclusions: CSA events occurring during CPAP titration are transient and self limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP related CSA.
Chest, May 2007

So for Kristy5550, the first thing you need to do is get your hand on your study results & see what they indicate. If it looks like they are potentially a major problem, then you will need to find a new sleep doctor to explore treatment options. I'm in the minority with pure CSA and no OSA, so a lot of things that might work for you were not an option for me. Plus things are changing every year as far as treatment of centrals- what we had 4 years ago seems archaic to me now that I'm on a VPAP Adapt finally, but even that still left me a double digit residual AHI.

jammin- glad to here you are still doing well with your Adapt. Its a wonderful machine for those of us who need it, though I do question how some of its functions & tendencies would affect a more typical straight OSA person. Which mask are you using with your Adapt?

[Sammy_J]

Wow, 3 year old thread but it caught my eye.

Have a look here on the latest published report on Complex Sleep Apnea. Most doctors, even sleep doctors are not trained in this area (yet).

http://www.medscape.com/viewarticle/515202

[rested gal]

Leave it to you to ARGUE a 3-YEAR OLD FRIGGIN POST!! People can't even discuss that topic any longer without having you ragging on them.

Not everyone needs an Adapt SV, one day you will figure that out.

Well, Christine is not the person who brought this thread to the surface (not that there's anything wrong with that.) Once brought up to the first page again, I think it's good that anyone who sees something in it they want to comment on does so. Christine's post was extremely informative and could be very useful to new people (and old... )

Oh, and anyone who actually has taken the time to read and think about what Christine has posted in other threads about centrals and about the Adapt SV machine would know that FAR from suggesting "everyone needs an Adapt SV", Christine has been very clear about saying it is a machine designed for a very specific purpose and is not a good choice for the vast majority of people with sleep disordered breathing...not even those who experience some centrals but have Obstructive Sleep Apnea as their primary disorder.

I'm happy to see Christine's great posts in any thread of any age. She knows this stuff. We can all learn a lot about centrals and about the Adapt SV from her.

[WearyOne]

Leave it to you to ARGUE a 3-YEAR OLD FRIGGIN POST!! People can't even discuss that topic any longer without having you ragging on them.

Not everyone needs an Adapt SV, one day you will figure that out.

Jammin' is the first post (6/12/07) since titrator's post in 2004. Christine quoted titrator's 2004 post, but that was in response to jammin's post. No problem with bringing up an old post if you have something new and/or positive to add to it, you have questions on the subject, or you just want to share your experiences with that topic.

Christine is very knowledgeable about this and I don't see that she's shoving Adapt SV down anyone's throat, or anywhere close to it.

I enjoy reading about everything releated to apena, even if it doesn't directly affect me.

Pam

[jammin]

Hey Guys,

I didn't even notice the date when Kristy had posted this. I just saw it in the index and thought she might be going through the same thing I am, and thought I could post something useful. I'll pay more attention next time. Sorry for dragging up old news.

[rested gal]

jammin, you have nothing to apologize for at all. Someone else, today, could be wondering about the same thing that Kristy asked. You did them a favor! And so did Christine.

[WearyOne]

jammin, I think it's great to bring up old topics because, as rested gal said, you never know if someone is dealing with the same issue right now and could use the information!