O2 Desaturations and Periodic Breathing on XPAP

[Taff]

If you are on xpap, what is considered significant O2 desaturations warranting further investigation, especially if this occurs during episodes of periodic breathing?

I've noticed that every night there is periodic breathing present (less than 10%), and most nights there is usually 2-3 desat events in that time frame: Desat at 85% for 10-30 seconds, basal O2 is 95% +

I've ruled out leaks as a contributing factor.
Auto is set at 10-11 cm of water, and AHI is between 2-6.

I'm wondering what the next step would be in addressing this, or if it even would be addressed?

[snnnark]

Any desat below 88% is considered significant. I would bring this to your doctors attention.

[Taff]

Any desat below 88% is considered significant. I would bring this to your doctors attention.

Snnnark, thanks for the reply! I thought so too.

I'll be looking for another doctor (in the Toronto area, anyone have recommendations?) I've already showed the data to the current doc at the last appointment and he brushed it off, looking at the AHI, ignoring the desats on the pulse ox data, and saying 'doctors don't really prescribe O2 for that' and that the results look alright.

Is supplemental oxygen the way to go, or if it would require to test another type of machine (ASV)?
Does anyone have any experience with this?

Thanks for any input.

[LoQ]

Is supplemental oxygen the way to go, or if it would require to test another type of machine (ASV)?
Does anyone have any experience with this?

I think the first step would be to see if those desats were correlated with untreated obstructive events. If they are, then you need more effective PAP therapy, at minimum. I cannot answer the question about what form that PAP therapy would take.

[snnnark]

I take it that this data is for your DH? Does he have any heart issues that could be causing the PB?

Would it be possible to post an example of the PB and the summary data for a typical night?

If it is genuine PB then Bipap ST would probably be the next step. After that is ASV. If the basal o2 is 95% then I doubt oxygen is required.

First prize, of course, would be to find a competent Doc that will be able to diagnose and treat DH!


p.s. I am not a doctor and only once played one in a school play!

[Taff]

Snnnark, it is for my DH and he has heart disease. (I'm the supportive spouse, in-home investigator and researcher and patient advocate.)

Finding 'competent' doctors is on the top of our list right now. To suggest some doctors are incompetent, ruffles feathers because even the incompetent ones 'have gone through so much schooling' (even if they finished bottom of their class.) I'm not a doctor either, but I play one at home.

At this point, I'm not sure I want to go back to the GP to ask him for a referral for anyone else, as he is the one who referred us to the current clinic/doc. I may just go to the research university and see what happens.

LoQ, thanks for your input. It seems that most of the desats are happening at untreated obstructive events.

I've added the data below. The first half of the night was spent wearing the hybrid, the second half spent wearing the Swift Fx nasal pillows. (Very different looking leak lines).
Auto setting last night: 10-12

Data with the added Oximetry graph:



Summary of Daily Events per Hour:



SP02 details:

[HoseCrusher]

Taff, interesting data...

It looks like the machine tried to respond to the OA, but bumped up against the high limit you have set. I am looking at the events at roughly 2:30 and 4:20.

Looking at the SpO2 and pulse rate data, the OA events occurred during desaturations, and the heart rate increased during those desaturations. Your report shows that a little over 10 minutes was spent at oxygen levels below 90%.

It seems reasonable to speculate that if you increased the pressure a little, you may be able to eliminate the obstructive events, and that would improve the oxygen saturation.

The leak pattern is interesting, but the amount of leakage is well within the machines capacity to compensate for. It is my opinion that your primary goal should be to eliminate the OA events and improve the oxygen levels. Once you achieve that you can then sort out the other issues including the leak rate. However, keep in mind that if you raise the pressure and it all leaks out, that would be counter productive. Leaks are important when they interfere with treatment but I feel that at this point in time oxygen levels are more important.

[snnnark]

How interesting is that 2nd half of the night? The leaks are worse on the FX but the data (esp. the last 2.5 hours) is much better. And on that subject why are the leaks so low? I thought the Respronics did not compensate for vent so your leak should be around 50l/m for the hybrid and 35l/m for the FX (according to http://www.internetage.com/cpapinfo/leak-rates-1.html) But I do know that sometimes Encore has a problem reporting leaks.

Perhaps your doc has thought "hmm, AHI down to 5. Job done!" What you need to find is a cardiopulmnorespiratorologist(tm) who will be interested in all aspects of DH's therapy!

Keep us posted.

[Bright Choice]

I'm watching this post with interest because I am also watching my desats. I have an md who listens and is supportive. He said to watch the desats and try adjusting pressure to see if it decreases desats. So far I have not noticed a relationship between desats and pressure. He said to try to keep desats of under 88% to less than a minute (I live at 6200 ft). I do know that when desats of under 88% are less than a minute I feel ok the next day. When they are anything higher than 1 minute, ie highest was 5.7 minutes - I feel "hungover" the next day. Even 1.2 minutes is not great.

I am unsure about whether or not I have periodic breathing. It does seem that there is no relationship between desats and apneas or hypopneas.

I am absolutely not writing this in terms of giving advice because I am very new to this. Just sharing my experience and also looking for comments from others. I am also curious about when supplemental o2 is added.

I see that you must have a Contec / CMS oximeter. What one do you have? I have the 50F and it broke after 2 weeks. I looking into warranty and also ordering another because I really liked it. You are probably aware, the number of minutes under 88% shows on your report. In your example, it was 0.2 minutes.

Good luck with finding a supportive md!