Central Apeneas Dominant

[chuckiejones]

My sleep study found that I had 17 central vs 6 OSAs and 2 hyponeas. Is it logical to treat the predominant central problem with CPAP?

[Wulfman]

Maybe.
It might depend on at what pressure they occurred.
Otherwise a Bi-Level machine or ASV-type machine might work better.

Were you prescribed a CPAP.....and if so, what pressure?


Den

[Big Daddy RRT,RPSGT]

Are these diagnostic results or CPAP titration results? For example 25 respiratory events divide it by 6 hours of sleep AHI=4.2 hardly even have sleep apnea. A two hour split night? AHI=12.5 More information might help.

[sleepmba]

I've seen people in the lab have a few/quite a few centrals because they were having a hard time with xPAP. Yes, more info is needed.

[elena88]

My goodness, asian escorts have osa too?
You see, lots of people dont fit the usual profile.




Yoo hoo experts!
Okay, I have a question! what else is new?

If you have six centrals per hour, that is above the magic five number....

would anyone bother treating a person for that? Lets say they were less than twenty seconds.. would you be looking at O2 levels, and would
that factor in, or would the magic six number be enough to show someone was being "disturbed" while they were sleeping?

I mean someone with ZERO obstructive, do you get any people like that?

[Big Daddy RRT,RPSGT]

Primary Central sleep apnea is indeed a diagnosed condition although I have never seen a mild case. It's been severe in all the cases I've seen. Cardiac or Neurological it has tended to be something that happened all night long. That's why Auto-SV and V-pap adapt were invented.

If you had mild central sleep apnea and suffered symptoms treatment would be warranted. You might try CPAP first to see if the centrals were actually obstructive apneas that looked like centrals. Let me explain. Most people's airway closes and they struggle to breath until they gasp open their airway. You see a flat air flow reading and continued chest movement. In a true central apnea the airway is open, no effort (chest mvt). However when some people have a obstructed airway don't have the chest mvt you normally see, or so little you can't pick it up during the recording. This records like a central but if you monitored the airway directly you would see it was closed. These people respond to CPAP, true primary Central Sleep apnea does not.

[elena88]

Primary Central sleep apnea is indeed a diagnosed condition although I have never seen a mild case. It's been severe in all the cases I've seen. Cardiac or Neurological it has tended to be something that happened all night long. That's why Auto-SV and V-pap adapt were invented.

If you had mild central sleep apnea and suffered symptoms treatment would be warranted. You might try CPAP first to see if the centrals were actually obstructive apneas that looked like centrals. Let me explain. Most people's airway closes and they struggle to breath until they gasp open their airway. You see a flat air flow reading and continued chest movement. In a true central apnea the airway is open, no effort (chest mvt). However when some people have a obstructed airway don't have the chest mvt you normally see, or so little you can't pick it up during the recording. This records like a central but if you monitored the airway directly you would see it was closed. These people respond to CPAP, true primary Central Sleep apnea does not.

Thank you Big Daddy! That is facinating that central sleep apnea is always severe. I see that no chest movement would indicate an central.
I know the cpap/apaps cant treat a central. How exactly do the auto Sv's V-paps stop a central apnea? In what way do they differ from a regular
cpap/apap if you have the time to tell...

[ldj325]

Primary Central sleep apnea is indeed a diagnosed condition although I have never seen a mild case. It's been severe in all the cases I've seen. Cardiac or Neurological it has tended to be something that happened all night long. That's why Auto-SV and V-pap adapt were invented.

If you had mild central sleep apnea and suffered symptoms treatment would be warranted. You might try CPAP first to see if the centrals were actually obstructive apneas that looked like centrals. Let me explain. Most people's airway closes and they struggle to breath until they gasp open their airway. You see a flat air flow reading and continued chest movement. In a true central apnea the airway is open, no effort (chest mvt). However when some people have a obstructed airway don't have the chest mvt you normally see, or so little you can't pick it up during the recording. This records like a central but if you monitored the airway directly you would see it was closed. These people respond to CPAP, true primary Central Sleep apnea does not.

Regarding this statement: "so little you can't pick it up during the recording." Is the recording you are referring to the recording as done by machines such as the S9? Or do you also mean professional recording that is done in the lab will also miss the chest movement and misidentify as a central apnea?

[NotMuffy]

In a true central apnea the airway is open...

Sez who?

Pharyngeal narrowing/occlusion during central sleep apnea
M. S. Badr, F. Toiber, J. B. Skatrud and J. Dempsey
Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705, USA.

We hypothesized that subatmospheric intraluminal pressure is not required for pharyngeal occlusion during sleep. Six normal subjects and six subjects with sleep apnea or hypopnea (SAH) were studied during non-rapid-eye-movement sleep. Pharyngeal patency was determined by using fiber-optic nasopharyngoscopy during spontaneous central sleep apnea (n = 4) and induced hypocapnic central apnea via nasal mechanical ventilation (n = 10). Complete pharyngeal occlusion occurred in 146 of 160 spontaneously occurring central apneas in patients with central sleep apnea syndrome. During induced hypocapnic central apnea, gradual progressive pharyngeal narrowing occurred. More pronounced narrowing was noted at the velopharynx relative to the oropharynx and in subjects with SAH relative to normals. Complete pharyngeal occlusion frequently occurred in subjects with SAH (31 of 44 apneas) but rarely occurred in normals (3 of 25 apneas). Resumption of inspiratory effort was associated with persistent narrowing or complete occlusion unless electroencephalogram signs of arousal were noted. Thus pharyngeal cross-sectional area is reduced during central apnea in the absence of inspiratory effort. Velopharyngeal narrowing consistently occurs during induced hypocapnic central apnea even in normal subjects. Complete pharyngeal occlusion occurs during spontaneous or induced central apnea in patients with SAH. We conclude that subatmospheric intraluminal pressure is not required for pharyngeal occlusion to occur. Pharyngeal narrowing or occlusion during central apnea may be due to passive collapse or active constriction.

http://jap.physiology.org/cgi/content/a ... /78/5/1806

NotMuffy

[Big Daddy RRT,RPSGT]

ldj325 said...Regarding this statement: "so little you can't pick it up during the recording." Is the recording you are referring to the recording as done by machines such as the S9? Or do you also mean professional recording that is done in the lab will also miss the chest movement and misidentify as a central apnea?

Typical professional recording records airflow and chest mvt...so no flow and no chest mvt then you call it a central apnea.

The S9 is described as delivering air to check the status of the airway during an apnea so apparently it can tell the difference which is an advantage in it's reports however you can't use an S9 to diagnose sleep apnea but rather to Auto titrate. During a Sleep Lab titration the application of more pressure will tell the story...more pressure eliminates the apneas or makes them worse.

[Big Daddy RRT,RPSGT]

Interesting study about central apneas, during a central the airway closes anyway so CPAP pressure might help? In the lab we often find CPAP pressure makes central apnea worse. Not sure what the implications of this study could be but it is very interesting.

[Big Daddy RRT,RPSGT]

Elena88 said...Thank you Big Daddy! That is facinating that central sleep apnea is always severe. I see that no chest movement would indicate an central.
I know the cpap/apaps cant treat a central. How exactly do the auto Sv's V-paps stop a central apnea? In what way do they differ from a regular
cpap/apap if you have the time to tell...

I have seen only severe central sleep apnea, but I did not mean to imply it would always be severe. Certainly mild is possible but the treatment becomes less obvious with any mild condition. Do you fell better when we treat mild OSA sometimes yes, sometimes no. Central Sleep apnea?

To over simplify the Auto-SV and VPAP Adapt essentially ventilate you during a central apnea. They monitor your breathing and deliver controlled breaths in time with your previously spontaneous breathing, hopefully at the same rate and depth as your spontaneous breathing to prevents oxygen desats and arousals.

[JohnBFisher]

The following is Rested Gal's:

Links to Central Apnea
viewtopic.php?p=457566

Of particular interest for the original poster is the following article:

Efficacy of Adaptive Servoventilation in Treatment of Complex and Central Sleep Apnea Syndromes
http://chestjournal.chestpubs.org/conte ... l.pdf+html

As "Big Daddy RRT, RPSGT" notes, the ASV unit helps sustain breathing during an apnea episode. By doing this, it helps break the undershoot/overshoot cycle that tends to exist with central apneas. That is, for whatever reason, your body fails to breathe enough (this is the undershoot side of the cycle). CO2 builds up until your body starts the normal respiration cycle. But by this point your body recognizes that it needs to catch up, so you tend to breathe a little more frequently until your CO2 limits fall to an acceptable level. However, it tends to overcompensate and decreases the CO2 level to the point your breathing again slows and/or ceases. This is the overshoot side of the cycle. Since breathing once again slows/ceases you again have an apnea, the CO2 builds up and away you go again.

By sustaining the breathing during the undershoot side of the cycle, it tends to break the tendency to overshoot. This means you might have one apnea, but only rarely will have repeated apneas.

As others noted, there is good evidence that treating the obstructive side of the apnea may in itself break this cycle. And unfortunately, you will need to follow along that path to find what works for you. This is why some people need to try CPAP, then BiPAP then an ASV unit. It seems frustrating, but it really will help you in the long run. You want the doctors to use the least amount of therapy / also the less expensive therapy first. If that does not work, then you move to the next level. An ASV unit - even with a good healthcare plan - costs a lot of money.

Hope that helps.

[geoffc]

Just a quick note of experience from someone with Complex Sleep Apnea, My AHI during my diagnostic study was 117, with 0 Obstructive, 50 Hypopneas and 67 centrals an hour.

I did a titration on a bi-pap and my AHI was only down to the 60's, again, 0 obstructive.

I then did an ASV titration and now have an ASV Machine.

My ahi now ranges from 6-12 with 0 apneas, only hypopneas. I've only been on therapy for about 45 days, and my Doc this morning suggested my body is still adjusting to therapy, they want to see a data download in 3 weeks before then tweak any settings to see if we can get my AHI down some more.

As a Side note, if anyone needs a good Dr or DME in Atltanta or any of North GA, I'll pass on where I go. The DME spent an hour and a half this morning helping me find a back up mask that work work with my machine and didn't leak at my pressures (FYI- Fisher & Paykel Masks will not work with a Resmes vpap ASV) . I finally left with a Mirage Liberty, I think I'm going to try it tonight.

Geoff