CPAP specifically for PVCs?

[lars_the_bear]

Hi folks

About six months ago I suddenly started getting frequent (thousands per day) PVCs (ventricular ectopic beats). This isn't a thing that built up gradually -- one day I was fine, the next I had these PVCs. I know they don't bother some people, but I feel every single one.

I saw a cardiologist and had all the usual tests, all turned out to be fine. In addition, I don't drink coffee or alcohol, I don't take recreational drugs, I get plenty of exercise, I have a healthy diet, yadda, yadda. There is no explanation for these PVCs, apparently, with the _possible_ exception of some kind of sleep-disordered breathing.

I'm a thick-necked, 55-year-old man, and I certainly look like somebody who would be prone to OSA. However, I have no other symptoms, with the possible exception of the cardiac ones. I don't snore, I'm not tired during the day, I have pretty good exercise tolerance (I run or cycle most days), and generally feel well. In fact, apart from the darned PVCs, I consider myself in perfect health. So do my doctors.

I had two sleep studies, with conflicting results. The first said AHI < 5%, the second AHI ~20%. On the strength of this later one, the cardiologist thought that CPAP might be a good idea. I think this was a kind of shoulder-shrugging reaction, having exhausted all other possible explanations. In any event, it wouldn't do any harm.

To cut a longer story short (well, shorter) I've been on CPAP a few days, but I can't say it's made any difference to the PVCs yet. And, of course, it hasn't made any difference to any other symptoms, since I don't have any. With my lack of symptoms and ambivalent test results, I'm far from convinced that I have any sleep disorder at all. The suggestion to try CPAP seems to be based primarily on my physical appearance, age, and presence of frequent PVCs.

So what I'm wondering is this:

1. Has anybody else been advised CPAP for cardiological reasons, in the absence of any of the more common OSA symptoms?
2. Did it work?
3. How can you even tell if the CPAP equipment is working/adjusted properly/etc, if you have no symptoms?

Suggestions welcome.

Best wishes
Lars

[LSAT]

I have had PVCs for years...One time I wore a 24 hour monitor that showed 25-30% of my beats were PVCs. My normal heartbeat is 70-80 which means that I had about 20-25 per minute. Recent testing has shown that they are currently lower than that. I have been taking a beta blocker for many years so my cardiologist said that we will just watch it closely. The PVCS have never bothered me and I rarely feel them. He suggested that I use the Kardia Mobile device to periodically monitor my EKG on my phone. CPAP have made no difference with my PVCs.

https://store.kardia.com/products/kardi ... 85a5f8f992

[ChicagoGranny]

To cut a longer story short (well, shorter) I've been on CPAP a few days, but I can't say it's made any difference to the PVCs yet. And, of course, it hasn't made any difference to any other symptoms, since I don't have any. With my lack of symptoms and ambivalent test results, I'm far from convinced that I have any sleep disorder at all.

You can get good help from the forum if you use OSCAR and post a typical Daily Details chart. Please stick to this thread.

Which model machine are you using? Please put it in your signature line.

[lars_the_bear]

The PVCS have never bothered me and I rarely feel them [...] CPAP have made no difference with my PVCs.

Thanks. It's odd how some people are conscious of PVCs and some are not. I feel every single one like a slap around the face -- at least when I'm awake. I actually have a lot more of them when I'm asleep but, thank Heavens, I don't notice those. When they're bad, it's like atrial fibrillation -- a completely irregular heartbeat. But I met a chap half my age who had been in AF for three years, and said it didn't bother him at all. Oh, well.

It's disappointing (for me) that CPAP hasn't affected your PVCs; but I guess you aren't using it for PVCs, right? The evidence concerning the effect of OSA and CPAP on PVCs seems to be a bit conflicted. That's why I'm keen to hear from anybody who found that CPAP helped (or hindered) PVCs.

Best wishes
Lars

[lars_the_bear]

You can get good help from the forum if you use OSCAR and post a typical Daily Details chart.

Thanks. Fair enough. I'll post some details when I've figured out how to get them. I'm still at the stage where I feel I'm doing well if I can put my mask on the right way up. Computerized data analysis is still postgraduate stuff for me

Best wishes
Lars.

[ChicagoGranny]

I'm still at the stage where I feel I'm doing well if I can put my mask on the right way up.

If it works well upside down, go with it.

For your specific model of mask, there are good videos on youtube demonstrating proper fit and adjustment. Closely watching three or four videos can often be quite helpful.

[zonker]

You can get good help from the forum if you use OSCAR and post a typical Daily Details chart.

Thanks. Fair enough. I'll post some details when I've figured out how to get them. I'm still at the stage where I feel I'm doing well if I can put my mask on the right way up. Computerized data analysis is still postgraduate stuff for me

Best wishes
Lars.

first, welcome to the zoo!

beyond that, don't worry about the analysis. there are plenty of folk here (not ME!) who are well versed in reading those particular tea leaves.

good luck!

[palerider]

I was having a lot of PVCs, and somewhere I made a tenuous mental connection that some antihistamines can cause irregular heart rhythm. I stopped taking OTC zyrtek, and my heartbeat is regular now.

Not interested enough in confirmation to go back on the med.

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[Miss Emerita]

Lars, do you have copies of the two sleep studies? If so, could you black out personal information and post them here?

If you don’t have them, do you know the breakdowns of the types of events (obstructive apnea, central apnea, hypopnea)?

[Respirator99]

Hi Lars. Like you, I had PVCs (very disturbing) and was sent for a sleep test by my cardiologist after all other tests came back negative. Unlike you I actually had all the symptoms of sleep apnea but was living in denial. The sleep test showed an untreated ahi of 62, about 50% being central apneas. I went on to an ASV machine and the PVCs disappeared almost overnight. Eight years later they're still gone.

[lars_the_bear]

I went on to an ASV machine and the PVCs disappeared almost overnight.

Thanks. Can you remember how long "almost overnight" actually was? I guess eight years later it might not be all that clear.

I can tolerate CPAP, but I don't find it agreeable, and I don't have any other symptoms. So I'm reluctant to keep subjecting myself to it if it doesn't actually fix the problem.

Best wishes
Lars.

[lars_the_bear]

Lars, do you have copies of the two sleep studies? If so, could you black out personal information and post them here?

I'd be delighted to, but I wouldn't want to impose.

My first sleep study was organized by the UK National Health Service, and I don't have any detailed results other than "No significant sleep apnea". The second was done by a private medical institution, which I had to pay for (UK health insurers don't usually cover sleep disorders). For this I got a report about twenty pages long, full of graphs, none of which I really understand. It said that I had an AHI of about 20 (per hour), which was classed as "moderate". It also said that I had significant desaturations that weren't associated with airways obstruction.

I do not know if sleep anpoea can be so variable that it's zero one day, and "moderate" the next. Or whether one (or both) sets of equipment were faulty, or one was more sensitive than the other, or something else.

I do know that CPAP is a fairly intrusive thing to bring into your life, when you have none of the classic symptoms of OSA, and generally feel fine.

Best wishes
Lars.

[Pugsy]

I did a very quick read about cpap use and PVCs and from the quick read it seems like cpap itself would help reduce PVCs in roughly half the people. Now bear in mind the studies I read were people with documented OSA and PVCs were a side product. These people would have needed cpap even without the PVCs.
I didn't find any studies where cpap was used just for PVCs and OSA was absent....it was always in conjunction with OSA and PVCs together.

So even if you do or don't have OSA....cpap itself doesn't seem to be a definitive treatment all by itself for PVCs with a success rate of maybe 50%.

If you are still having a lot of PVCs...need to be talking to your doctor for sure...especially since you reported that on the second study they noted significant drops in O2 and NOT being related to airway issues. That's a big red flag to me.
Sleep apnea isn't the only thing in the world to cause desats....lots of other potential culprits and that would worry me.
I would expect desats with an apnea event but to have a desat not associated with an apnea event is worrisome IMHO.

[Miss Emerita]

Somewhere in those 20 pages is there a breakdown of events (obstructive, central, hypopnea)? Also, given Pugsy's comments, do you see anything stating how many minutes your O2 sats were under 90 (or 89, or whatever)? Or how many desats to that level you had?

[lars_the_bear]

...especially since you reported that on the second study they noted significant drops in O2 and NOT being related to airway issues. That's a big red flag to me.

Yeah. But... I've had cardiac stress MRI (twice), stress ECG, two holter ECGs, cardiac echo (twice), lung function/gas exchange both standing and supine, tests for thyroid, diabetes, electrolytes, vitamin deficiencies -- the list just goes on an on. I am, apparently, in perfect health. Apart from the PVCs and the peculiar sleep study. My doctors have latched onto the sleep study because they can't think of anything else. They keep telling me to try to ignore the problem -- as some people evidently can.

It seems that many people have frequent PVCs, much worse than mine in numerical terms, and never find out why.

For the record, the last page of the sleep study report says 153 respiratory events of which 129 obstructive apnoeas and 8 central apnoeas. Mean SpO2 91, range 84-98. There were 117 desaturation events of 4-9 percentage points, and one of 12 percentage points.

I'm happy to post the summary pages if anybody wants to see them but, as I said, I wouldn't expect this of anybody.

Although I'm no expert on this area of medicine, I have to admit that the sleep study results do like kind-of positive for mixed sleep apnoea. It seems odd to me that I have absolutely no symptoms, with the possible exception of these darned PVCs.

Incidentally, the PVCs started a couple of weeks after I had Covid (for the second time).

Best wishes
Lars.