Help with data interpretation, please

[CorgiGirl]

So I got my sleep study report, but haven't gotten to see the doc yet...help with understanding would be most appreciated. I know what most of these means as single items, but I'm having a bit of trouble putting it all together. Maybe it's the Sleep Apnea fog...

Slept for 312.5 min. of 474 min. recording time.
Sleep efficiency = 66%
Titrated from 10 to 20 cm H2O. "Difficult titration" are the words the doc used.
Switched to BiPap at 20/16 to 24/20. Bipap was not used long, but number of minutes not specified.
No REM sleep, 49% stage 1, 37% stage 2 and 14% slow wave sleep. (Too much stage 1, not enough stage 2 according to the comments)
65 central apneas
119 obstructive hypopneas
0 obstructive apneas
AHI = 35
Oxygen saturation during sleep 89%, while awake 97%
Periodic Limb Movement Arousal Index = 3

INTERPRETATION:
1) Difficult CPAP and BiPAP titration due to poor sleep efficiency and post-arousal central apneas. In addition to high mask leak. (No data provided on leak.)

2) Distorted sleep architecture.

Doc prescribed BiPAP at 22/18. I've had it for 4 days. Here's my 4 day data:

9% of night in Periodic Breathing
Central Apneas - 7.9
Obstructive Apneas - .7
Hypopneas - 3.3
Respiratory Effort Related Arousals - .6
AHI - 11.9

Large Leak - 48 seconds
Average Leak - 54.4 (expected leak/exhaust rate is 47 - 52 for these pressures)

IPAP 90% - 21.2
EPAP 90% - 18.2

Is this Complex Sleep Apnea?
What does it mean to have "post-arousal central apneas" as opposed to "pre-arousal central apneas?"
How do higher pressures alleviate central apneas?

I do know that I've gotten into REM the last couple of nights...I've had dreams and weird almost nightmares.
Thanks for reading this long thing and for your help.

CG

[jweeks]

Hi,

It looks like you are a complex person with a complex breathing problem. It appears that they really cranked the pressure up trying to treat the obstructive events. They were not entirely successful doing that. But in the process, they might have gotten the pressure so high that it is causing centrals. It is time to get a really smart sleep doctor, who might have you try a smarter breathing machine.

My first titration looked a lot like that. They went all the way to 29 on the pressure, and still couldn't get air forced down my windpipe. At first, they said I was untreatable. Then my sleep doctor had them try different sleep positions and elevating my upper body. This showed that I was highly position sensitive. I ended up at 13/20 on BiPAP, and it works really well as long as I stay off of my back.

The reason that I bore you with this story is to let you know that there is hope, but it might take a doctor with a lot of experience. You also want to get a sleep study done at a research hospital or a major cardiac center if you haven't done so already. These places will have options to try machines that have ST and servo technology, something that you will not find at shopping mall sleep centers.

-john-

[CorgiGirl]

Thanks, John. I will ask about ST and servo technology and whether or not they had it at the sleep center.

I think my doc is pretty smart, but maybe I need a second opinion....

Thanks again,
CG

[timbalionguy]

You definitely have some interesting data there. Sounds very much liike the reports I have received, only much worse.

If you are new to xPAP, some pressure-induced centrals are normal. But you are having a high rate of centrals without xPAP. I also see a significant amount of periodic breathing in there. Keep track of this stuff and tell your doctor soon. If this sort of stuff keeps up, you have a good likelihood of having complex sleep apnea, complex sleep apnea syndrome (pressure induced complex sleep apnea, often called CompSAS here), or maybe even both. You are very likely a candidate for an adaptive servo ventilator (ASV) machine. (I was recently diagnosed with CompSAS, but my case is quite mild compared to what you are observing. I am still waiting for my machine, and may just purchase one if I don't hear more soon.)

[CorgiGirl]

You definitely have some interesting data there. Sounds very much liike the reports I have received, only much worse.

If you are new to xPAP, some pressure-induced centrals are normal. But you are having a high rate of centrals without xPAP. I also see a significant amount of periodic breathing in there. Keep track of this stuff and tell your doctor soon. If this sort of stuff keeps up, you have a good likelihood of having complex sleep apnea, complex sleep apnea syndrome (pressure induced complex sleep apnea, often called CompSAS here), or maybe even both. You are very likely a candidate for an adaptive servo ventilator (ASV) machine. (I was recently diagnosed with CompSAS, but my case is quite mild compared to what you are observing. I am still waiting for my machine, and may just purchase one if I don't hear more soon.)

Sorry, I should have added this info. I had a sleep study in July 2008. I was diagnosed with mild to moderate OSA with almost no OAs and some OHs. I elected to get an auto-pap rather than doing a second night in the lab. I finally settled on 10 as my minimum pressure and this kept my OSA controlled with AHIs below 5. This all changed in May when my data started showing what appeared to be continuous apneas all night long and rising pressures. So I called my sleep doc and she ordered a second study with titration. The results of the second study are the on I posted.

I don't understand why you say I'm having a high rate of centrals without xPAP. This was a titration study, but I probably didn't make that clear. Again, I apologize for not being clear.

Thanks for your help.

CG

[ozij]

Your sleep lab study shows that your main problem is hypopneas which disturbed your sleep badly. They did not manage to observe you sleep with your obstructions controlled.

Basically, you're trying to sleep, you have a hypopnea waking you up (causing arousal) you take a deep breath or a few to cacht up ad get enough oxygen into your body, and then your aroused brain says "hey wait a minute there, we don't need that much air and oxygen all at once" and so you have a post arousal breathing pause, which, in medicalese in a post arousal central apnea.

I see no reason, at this point, to assume you central apneas are caused by pressure. According to the lab they happened when you were awake - not when your brain was asleep.

Complex sleep apnea is diagnosed when obstructive events have been well taken care of, and you start throwing central apnea left right and center while asleep. I don't see anything indicating that in your titration - they did not even manage to control your obstructive hypopneas, because they had you for too short a time on BIPAP.


O.

[Muffy]

Can you get a hold of the actual "raw data" (the ~100 meg files themselves)? Both diagnostic and titration nights.

You look to be WAY over-titrated. Right off the bat, based on the data you've presented, the most your EPAP ever should have been is "10" (EPAP is titrated to control obstructive apneas); however, the absence of REM makes any pressure selection arbitrary.

Arguably, the obstructive hypopneas could have been central in nature.

Muffy

[sleepmba]

Corgigirl,
I've performed some titrations that look similar to yours (except I rarely go that high in pressure). It looks like you may have had a hard time sleeping at the lab. This may cause some of that. I wrote a little about Central Apneas at my blog. The link is in my signature at the bottom. Check it out.

When your data started showing you were having lots of apneas all night, was your equipment in good shape and comfortable? Like you mask, hose, humidifier, etc?

It seems strange that you would need such a drastic change. Another retitration comes to my mind...maybe even with a different tech.

Keep us updated...good luck!

[ozij]

viewtopic.php?p=490055#p490055

viewtopic.php?p=490328#p490328

[CorgiGirl]

Thanks for the replies. I'm beginning to get the idea that my most recent sleep study was not all that helpful because I did not get to REM and because they did not control my obstructive events. Is that a fair observation?

Muffy, yes, I am planning to ask for the raw data. I assume that it's part of my medical record and therefore I can have access to it. Sounds like it's possible to request that it be in digital format rather than paper, yes? I guess I'll take a disc with me when I go to my appointment and see if they can/will do that for me.

Meanwhile, here's last night's data:

AHI = 8.5
CA = 5.5
OA = 0.2
H = 2.8
RERA - 0.4
Periodic Breathing = 14% of night

IPAP 90% = 20
EPAP 90% = 18

Thank you again! I'm soooooooo confused at this point.

CG