can OSA cause cerebellar atrophy or are they related

[mayur]

my father(57) is having OSA for last 3 year but he started using cpap this february and he has cerebellar atrophy symptoms from last november , he has co-ordination problem in walking and speech vocal problems and snoaring , dream enactment are because of OSA. and there is serious respiration problems after using cpap.
The only treatment my father is getting is just the cpap and a doze of clonazepam 0.25mg but there is no improvement through this treatment neither in OSA nor in cerebellar atrophy.

[ChicagoGranny]

Does he have a machine with data capabilities and software to check the effectiveness of the CPAP? (Most of us use this.)

If he is still snoring the therapy is not working well.

He could still be sleep deprived if the CPAP is not working well. Bad sleep deprivation can cause the symptoms you mention.

CPAP has to be "fine tuned" to work well and the software is needed for the fine tuning.

[Julie]

There is no way whatsoever that apnea is responsible for cerebellar atrophy, but the atrophy could possibly affect apnea in some way, possibly being related to central apnea (do you know if central apnea noted on his sleep study?). Has your father seen a neurologist, and been properly tested for the degree of atrophy he has and/or what other related problems might be involved? He should also see a pulmonologist who's familiar with his medical history. It's important to know what kind of cpap machine (or A-pap, Bipap, ASV, Vpap, etc.) your father was given as it may or may not be appropriate depending on the rest of his condition - many family doctors (if one prescribed the cpap) are not very familiar with apnea, or may not have completely understood that there could be a relationship between the atrophy and apnea... and if the wrong type of machine is used, then your father may not be getting treated adequately.

Could you also say what type of mask he's using and how well he was fitted for it, whether or not he's good about keeping it on all night, if it's comfortable and/or whether air leaks from inside routinely?

[ChicagoGranny]

Here are some examples of the reports that we use to manage our CPAP treatment - http://www.cpap-supply.com/Articles.asp?ID=150

[JohnBFisher]

... he has co-ordination problem in walking and speech vocal problems and snoaring , dream enactment are because of OSA. and there is serious respiration problems after using cpap. ... but there is no improvement through this treatment neither in OSA nor in cerebellar atrophy.

I have to agree that the cerebellar atrophy might lead to either central or obstructive sleep apnea. Essentially if the atrophy impacts the brain stem, then it may lead to central sleep apnea. However, those same coordination problems can lead to coordination problems during sleep. So, it can also contribute to obstructive sleep apnea.

As others have noted, it's important to get his apnea under control. Being tired due to poor sleep will only make all his other symptoms worse. Trust me, I *know* all too well. I have Sporadic OPCA (OlivoPonto Cerebellar Atrophy). Essentially that means no one else in the family has it and it appears to be degeneration of my brain stem and cerebellum. It continues to progress. And when my sleep is poor, my symptoms are worse. Also when my symptoms are worse my sleep is also worse than normal.

Hope that helps.

[avi123]

my father(57) is having OSA for last 3 year but he started using cpap this february and he has cerebellar atrophy symptoms from last november , he has co-ordination problem in walking and speech vocal problems and snoaring , dream enactment are because of OSA. and there is serious respiration problems after using cpap.
The only treatment my father is getting is just the cpap and a doze of clonazepam 0.25mg but there is no improvement through this treatment neither in OSA nor in cerebellar atrophy.

Reply,

Several studies done in 2004 and 2009 have indicated that:

1) Frontal lobe white matter lesions are known to be associated with cognitive executive dysfunction. The findings of this study may offer an explanation for the sometimes irreversible cognitive deficits associated with sleep apnoea.

Source:

http://www.ncbi.nlm.nih.gov/pubmed/15572542

2) "It has been proposed that, in a subgroup of patients, OSAS per se may promote irreversible anoxic brain damage affecting the prefrontal cortex 28, 29. This hypoxic damage may underlie persistent sleepiness and cognitive dysfunction despite treatment. It remains unclear why one individual OSA patient may or may not develop this kind of lesion. "

Source:

viewtopic/t79622/posting.php?mode=quote&f=1&p=724378

[ChicagoGranny]

avi, I was looking for that. I knew there were studies showing untreated apnea causes brain damage.

So the question is, did cerebellar atrophy cause central apnea or did apnea cause brain damage which has been diagnosed as cerebellar atrophy?

[mayur]

well he is using a Resmed auto s9 escape its a auto but the pressure is confined to 12-16, the software we are using is resScan3 i agree with you the therapy is not showing its results,
do you think that it could be central osa .

Does he have a machine with data capabilities and software to check the effectiveness of the CPAP? (Most of us use this.)

If he is still snoring the therapy is not working well.

He could still be sleep deprived if the CPAP is not working well. Bad sleep deprivation can cause the symptoms you mention.

CPAP has to be "fine tuned" to work well and the software is needed for the fine tuning.

[ChicagoGranny]

well he is using a Resmed auto s9 escape its a auto but the pressure is confined to 12-16, the software we are using is resScan3 i agree with you the therapy is not showing its results,

If he truly has the auto S9 Escape the machine does not record efficacy data. This is unfortunate.

Is there a chance that you could upgrade to a "data" machine?

You can check which machines have data capabilities here - http://www.resmed.com/us/products/s9_se ... c=patients

Just select the machine and look for a green check mark beside "Efficacy data on data card". Members can guide you to a good machine. I personally recommend ResMed S9 Autoset.

do you think that it could be central osa

If he had a sleep study the answer will be in his records. The data capable ResMed machines also do a pretty good job distinguishing between central and obstructive.

[avi123]

Well, given John Fisher's post and this data:

Olivopontocerebellar atrophy

OPCA; Olivopontocerebellar degeneration; Multiple system atrophy – cerebellar predominance; MSA-C

Last reviewed: August 27, 2010.


http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001765/

It tells me that my above post covers something else. My post covers atrophies in the frontal brain (and not in the cerebellum, which is in the back), that could have been caused by the a CPAP treatment.

FRONT


If mayur's DAD has Olivopontocerebellar atrophy then the CPAP is used, most likely, to lighten the situation and not to cure it.

[JohnBFisher]

... So the question is, did cerebellar atrophy cause central apnea or did apnea cause brain damage which has been diagnosed as cerebellar atrophy? ...

Unfortunately, there is just one way to know for sure on this one. If the cerebellar degeneration continues .. even after the proper therapy to address the obstructive and central apneas, then the progression shows that the apnea is probably a result of the degeneration .. not the cause. And I suspect (though I can not prove it) that is far more common than the other way around.

[mayur]

thanks for your interest as john fisher is actually concerned that it could be OPCA but first of all its a OSA and REM ,
my docs are not in a state to confirm the MSA but is cpap the only treatment for this disease, which is actualy not working in any way for my father .

Well, given John Fisher's post and this data:

Olivopontocerebellar atrophy

OPCA; Olivopontocerebellar degeneration; Multiple system atrophy – cerebellar predominance; MSA-C

Last reviewed: August 27, 2010.


http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001765/

It tells me that my above post covers something else. My post covers atrophies in the frontal brain (and not in the cerebellum, which is in the back), that could have been caused by the a CPAP treatment.

FRONT


If mayur's DAD has Olivopontocerebellar atrophy then the CPAP is used, most likely, to lighten the situation and not to cure it.

[Julie]

Why doesn't someone ask a neurologist instead of trying to play House?

[mayur]

thanks for your interest sir,
do you think that constipation and urinary difficulties are the progress symptoms of MSA ,cause my father is presently suffering from both problems and i read it somewhere also.and his apnea is also not in control. so could it be a progress of OSA to MSA

... he has co-ordination problem in walking and speech vocal problems and snoaring , dream enactment are because of OSA. and there is serious respiration problems after using cpap. ... but there is no improvement through this treatment neither in OSA nor in cerebellar atrophy.

I have to agree that the cerebellar atrophy might lead to either central or obstructive sleep apnea. Essentially if the atrophy impacts the brain stem, then it may lead to central sleep apnea. However, those same coordination problems can lead to coordination problems during sleep. So, it can also contribute to obstructive sleep apnea.

As others have noted, it's important to get his apnea under control. Being tired due to poor sleep will only make all his other symptoms worse. Trust me, I *know* all too well. I have Sporadic OPCA (OlivoPonto Cerebellar Atrophy). Essentially that means no one else in the family has it and it appears to be degeneration of my brain stem and cerebellum. It continues to progress. And when my sleep is poor, my symptoms are worse. Also when my symptoms are worse my sleep is also worse than normal.

Hope that helps.

[mayur]

actually the sleep apnea started around 3 years ago but the cordination problems like disbalance in walking and slurred speech started around 10 months back, he is using a APAP resmed auto s9 escape with pressure 12-16(min-max) and the mask is mirage quattro full face mask.
i have been to a lot of neurologist but the results till now are not in good.
can you suggest anything more on this.

There is no way whatsoever that apnea is responsible for cerebellar atrophy, but the atrophy could possibly affect apnea in some way, possibly being related to central apnea (do you know if central apnea noted on his sleep study?). Has your father seen a neurologist, and been properly tested for the degree of atrophy he has and/or what other related problems might be involved? He should also see a pulmonologist who's familiar with his medical history. It's important to know what kind of cpap machine (or A-pap, Bipap, ASV, Vpap, etc.) your father was given as it may or may not be appropriate depending on the rest of his condition - many family doctors (if one prescribed the cpap) are not very familiar with apnea, or may not have completely understood that there could be a relationship between the atrophy and apnea... and if the wrong type of machine is used, then your father may not be getting treated adequately.

Could you also say what type of mask he's using and how well he was fitted for it, whether or not he's good about keeping it on all night, if it's comfortable and/or whether air leaks from inside routinely?