High AHI without SPO2 drops

[theSleeper]

Hi all,

Reading here for a while.
As I'm rather into self-titration, mostly due to the lack of specialist in the neighborhood, I'm following my progress carefully.
I decided to get a SPO2 logger (CMS-50E). Mostly to check if the events logged by the Respironics APAP actually lead to drops in SPO2 levels. And with that, to check if they are actually events.

After 2 nights of logging the SPO2 data, it seems there are no drops below 90%. It seems all values are above 93%. This while still having an AHI of 13 last night. Very few OA, the rest CA and H events. CSR at 20%.

I understand that the drop in SPO2 results in an event that wakes you up slightly and prevents you getting into a deep sleep. With these drops missing, the sleep should be OK. Adrenaline peaks should not be there either.

What I noticed as well is that due to the CSR, often drops in breathing are detected resulting in H-events.
The CSR I should not worry about according to a cardiologist. The APAP is propably the source of that.

Regarding how I feel; in my opinion not as it should.

Did anybody experience the same ?.

Thanks,

Sleeper.

[ozze_dollar]

sorry buddy most of that went over my head.

[theSleeper]

No worries, most of the time your sleep doctor takes care of this stuff.
I'm sure thought that some people know pretty well what this is about.

[Lizistired]

What is CSR?

[mars]

Hi Sleeper

After 2 nights of logging the SPO2 data, it seems there are no drops below 90%. It seems all values are above 93%. This while still having an AHI of 13 last night. Very few OA, the rest CA and H events. CSR at 20%.

The first thing I would mention is that we are looking for an AHi of 5 or less. Your AHi of 13 would be a matter of concern for most of us.

I usually got an AHi of round about 3, which multiplied by 7 hours gives us 21 events over a nights sleep. And when checking the night with my oximeter there would be no desats less than SpO2 90. Similar to yourself. But because of other factors (reflux, plmd etc) I was not getting restful sleep.

So my suggestion would be to first of all get your AHi down to less than 5, and check what your sleep study says about other factors.

Good luck

Mars

[theSleeper]

Mars, thanks for your feedback.

My API reaches an average over 7 days between 5 and 8. Some better nights and some worse of course.
During my initial sleepstudy SPO2 went down to 70% with an average AHI of 30. Results are there for sure.
I have my doubts if the APAP device correctly detects some events.

For others: CSR = Cheyenne Stokes Respiration... wikipedia helps... in short; depth of breathing goes up and down in a wave form. More advanced APAP devices detect this and indicate this in the reports.

[milw]

Like you, I got the CMS 50-E, and on first night recording didn't go below 92% spO2, even though AHI on that night was above 12. My average AHI is running 10.4 on the auto mode, but I see the technician this coming Friday to convert to straight CPAP, we'll see if that gets the AHI down where it ought to be.

[rested gal]

theSleeper, what pressure was prescribed by the doctor after your sleep study?

What pressure range (minimum/maximum) is set on your autopap?

[robysue]

I decided to get a SPO2 logger (CMS-50E). Mostly to check if the events logged by the Respironics APAP actually lead to drops in SPO2 levels. And with that, to check if they are actually events.

There are many folks (like myself) here on the board who don't routinely desat with our apneas and hypopneas---at least according to our diagnostic studies. The arousals themselves can cause serious physiological problems in the long run; and that's why there is an increasing emphasis on treating folks like me who have very few apneas and/or hypopneas with desaturation, but who have tons of hypopneas with arousal on our diagnostic study.

After 2 nights of logging the SPO2 data, it seems there are no drops below 90%. It seems all values are above 93%. This while still having an AHI of 13 last night. Very few OA, the rest CA and H events. CSR at 20%.

If you are talking about one particularly bad night when your overall numbers decent (AHI near, or preferably below 5, CSR very low---as in low single digits), I'd be a bit worried if I were you, but I would also try to keep things in perspective. But if these were MY typical overnight numbers night after night, I'd be EXTREMELY concerned---even without any O2 desats. They are just plain too high. And the CSR with associated CAs and Hs AND a history of some kind of heart condition? Seems to me that under those conditions, this data SCREAMS for some kind of real evaluation rather than a glib dismissal from the cardiologist.

I understand that the drop in SPO2 results in an event that wakes you up slightly and prevents you getting into a deep sleep. With these drops missing, the sleep should be OK. Adrenaline peaks should not be there either.

No. The adrenaline peaks are associated with arousals regardless of whether the arousal had an associated desat or not. And the OSA arousals MAY happen SOON enough to prevent the desats you are expecting. Think of UARS-type events: In a hypopnea (or apnea) with arousal but no desaturation you start having some serious trouble getting air into the lungs for several breaths in a row or you miss a couple of breaths entirely (so the events are a bit more than 10 seconds or so). Your brain & body are sensitive enough to tell SOMETHING is wrong BEFORE your O2 level starts to drop. So it goes into "flight or fight" to fix whatever is wrong, and that means the brain recognizes something is wrong, sends enough adrenaline through your system that helps you arouse (among other things) and arousing allows the body to start breathing normally again---all BEFORE an O2 desat can occur.

Hence it's quite possible for a person to have OSA, but also happen to wake up/arouse repeatedly BEFORE the O2 level starts to go down because his/her body is sensitive enough to tell SOMETHING is wrong early in the process.

What I noticed as well is that due to the CSR, often drops in breathing are detected resulting in H-events.
The CSR I should not worry about according to a cardiologist. The APAP is propably the source of that.

If I were you, I'd want that cardiologist to very carefully explain why he/she believes the APAP is causing the CSR. And does he/she apparently thinks you'd have little or no CSR without the APAP? And that it only started when you started on APAP? And if so, why? Because 20% time in CSR and relatively high number of C's and H's associated with the CSR seems to indicate to me (a mere patient) that your therapy still needs some (possibly serious) tweaking to become genuinely effective. Particularly when you finish up by saying:

Regarding how I feel; in my opinion not as it should.

Did anybody experience the same ?.

There's a long time poster here by the name of JohnBFisher who after a very long struggle with less than effective therapy on CPAP/APAP/BiPAP was finally diagnosed with Complex Sleep Apnea among other things. I believe he is also somewhat knowledgeable about CSR. You might want to search for posts from John or pm him. He's likely to tell you that IF you are dealing with CSR or Complex Sleep Apnea, that a straight CPAP/APAP might never properly treat your sleep breathing problems. And why you might need to start asking NOW about what machine is really appropriate for treating YOUR sleep disordered breathing and whether you need a more advanced machine like a BiPAP S/T (or VPAP S/T) or even an ASV machine.

At the start of the post you describe yourself as "self-titrating." Yes, sleep docs get a lot of badmouthing around here (often justified). But if these figures are typical and your cardiologist is brushing them off, I think you need to find a good sleep doc (they do exist) and ask him/her about the significance of these figures in light of your existing cardio problems (whatever they are). Which I assume are not trivial since you are already under the care of a cardiologist for some condition you didn't mention here.

Best of luck,

Sleeper.[/quote]

[theSleeper]

RobySue, Thanks for the detailed reply. Very much appreciated.

The cardiologist ignored the CSR related issues as I'm in my 30's, Play sports a few hours a week and am able to swim 100 laps in an hour. In his opinion there can't be a heart problem.

The sleepdoc I don't trust due to his carelessness and enormous hurry during the results. "these are the numbers, get a CPAP".

Prescribed a pressure of 9. But I have the feeling that the doc ignored 50% of the AHI being CA's in the initial sleep study.
Titration of a week with his APAP resulted in an AHI of 7-8 at an average pressure of 9.

Running APAP with 8-10 at the moment. I tried other settings on APAP in the past. Can't seem to get rid of the CA's and H's.
OA is always below 1-2. Rest are H's and CA's. Average 31 days of AHI is between 7 and 8. CA around 3-4; OA around 1; H around 3-4 average.
CSR is mostly between 5 and 10 with peaks to 20.

I tried reducing the pressure or making the range smaller as it might start off the centrals.
Time to find a sleepdoc that's interested. Where I live I needed to buy the APAP myself. I hope I won't need another type but won't stop to get one if needed.

Thanks for interest.

[HoseCrusher]

Robysue, in detailed discussions with my cardiologist the damaging adrenaline surge comes as a result of desaturation. There may be a slight adrenaline release upon arousal, but this does not seem to be any where near as damaging as the surge encountered during a desaturation.

The key to this is a change in heart rate.

I am under the impression that if there is an arousal without a change in heart rate, it is not necessarily unhealthy. But, if the arousal is accompanied by an increase in heart rate the heart is most likely responding to an adrenaline surge.

[archangle]

Here's how I think it works.

AHI counts the number of events.

An apnea can be 11 seconds or it can be 90 seconds and it gets counted the same in the numbers. The 11 second apnea will probably not show any desaturation. That's one of the good reasons to look at your flow waveforms.

[Bright Choice]

RobySue, Thanks for the detailed reply. Very much appreciated.

The cardiologist ignored the CSR related issues as I'm in my 30's, Play sports a few hours a week and am able to swim 100 laps in an hour. In his opinion there can't be a heart problem.

RobySue made some excellent points about CSR. Read and reread her post carefully. Listen to her advice. I would not let the comments of your cardiologist stop you from exploring your issues. CSR issues may or may not be caused by heart problems but they still need to be diagnosed and treated if necessary. That could necessitate a different xpap modality. I would definitely get a second opinion by finding someone who can address your issues with CSR and CA's. APAP will identify but will not treat CA's. In some people, CA's will disappear after a period of time on cpap, but that is not the case in all situations.

Get in contact with JohnBFisher on this site! Read his posts!

[theSleeper]

More good feedback. Thanks.
Good point on the duration. Looking at the waveforms, most apneas are short or in most cases, CA's like H events, just shallow breathing or missing a single breath. These would not cause a desaturation. Never more than 10-20 sec. Heartbeat stays consistently low most of the night (40-45 bpm). Last night was good. AHI of 6.2 CSR of 6%. Feeling good.

I will look for a sleepdoc though. I want to make sure I'm on the correct treatment. Will let you know when I have it.

[avi123]

thesleeper, you posted: What I noticed as well is that due to the CSR, often drops in breathing are detected resulting in H-events.
The CSR I should not worry about according to a cardiologist. The APAP is probably the source of that.

You can have CSR-CSA at any age and be able to do any activity. But your machine is not sensitive enough to show CSR Flow pattern.

Have you checked these:

viewtopic.php?f=1&t=66538&st=0&sk=t&sd=a

and

pg 5 here

viewtopic.php?f=1&t=66232&p=620169#p620169