Sleep Study: 0 CA. Diagnosis: CA

[theoldman22]

Below are some of the data from a sleep study done about a month ago. The MD who wrote the report is from out of town and not easily available. I have not been able to ask the RT who did the report. Could someone please tell me how a diagnosis can be Central Sleep Apnea when the data show 0 central apneas during the test? My untrained mind cannot say the diagnosis is incorrect but neither can it understand it.

Generally, when I do have a non-zero AHI, it normally consists of CA's--last night AHI was 0.8, CA 0.8. The night before both those numbers were 0.6. Occasionally, I do have a few hypopneas and OA's.

I do have trouble sleeping and have been on and off XPAP therapy for about 15 years. When using the machine, I do sleep slightly better, feel some better the next day, and do not have to urinate so often.

Now, if only I could use nasal pillows instead of a FFM without having to tape my mouth.

-------------------------------
Respiratory Data:

54 respiratory events were observed which included 0 central apneas, 0 mixed apneas, 2 obstructive apneas, 9 hypopneas and 43 RERAs. The apnea-hypopnea index was 2.6Ihour, which is normal. The amounts of apneas/hypopneas are evenly distributed, with a non-REM RDI of 12.61hour and a REM RDI of 13.2/hour. Respiratory events were more frequent in the non-supine positions. The longest respiratory event duration was 29.5 sec. Minimum NREM oxygen saturation was 89 ; minimum REM oxygen saturation was 89 . Time spent below Sa02 of90 was 0.0 min. Snoring was noted to be moderate.

Arousal:
52 arousals were observed, with a total index of 12.0Ihour. There were 2 spontaneous arousals, 18 respiratory arousals (respiratory arousal index of 4. 2lhour), 30 snoring-related arousals and 2 limb movement arousals (limb movement arousal index of O/lhour) arousals (respiratory arousal index of 4 2/hour), 30 snoring-related arousals and 2 limb movement arousals (limb movement arousal index of O/hour).
Impression:
1. Diagnostic Study had a diagnosis of Central Sleep Apnea 327.27
2. During the Titration Study the patient had an RDI of 12.7/hour and an AHI of 2.6/hour which was
improved with Bi-Level.
3. Sleep architecture was Fragmented

Under RECOMMENDATIONS the first item is:
1. ResMed Auto VP AP with Min EP AP at 8 cm H20 and Max IP AP at 13 em H20 wi Heated Humidification
and Heated Tubing.

[Julie]

This is what Dr. Stephen Park (a frequent contributor to this forum) had to say in 2009 -

"Essentially, there's no difference between RERAs, apneas and hypopneas. It's all in how we define obstructive sleep apnea, which is defined as the total number of apneas and hypopneas per hour on average. RERAs, even though you stop breathing and wake up, doesn't get counted, even though it disrupts your sleep and can lead to significant symptoms. The only difference between a RERA and an apnea is how long the breathing pause lasts: it can only be counted as an apnea or hypopnea is the breathing pause lasts 10 seconds or longer. If you stop breathing 25 times every hour but wake up after 1-9 second episodes, then your AHI is 0."

So whether you need Cpap, or possibly only treatment for positional apnea (are most of your symptoms occur when back sleeping vs on your side?) with e.g. a soft cervical collar, a real effort to not back sleep, and periodic checks of your 02 sats, or what, is for you to discuss with your doctor... the report is a bit confusing as it almost seems that calling your 'arousals' CAs is like a fallback position - they don't know what to say, so are calling it CA, but in fact, you had very few, and very many of us have those when transitioning to sleep, and on awakening, and they are not of much consequence... it's only when there are many, and throughout the night, that you should be concerned.

[Pugsy]

Typo or dictation error maybe?
Was any part of this sleep study without cpap/titration? Or was it all titration?
I don't see it either.

[tortoisegirl]

Was that listing of 54 respiratory events (majority RERAs) from a titration study (with xPAP)? I assume this as the AHI would be too low to recommend xPAP otherwise, and "Impression: 1. Diagnostic Study had a diagnosis of Central Sleep Apnea 327.27" implies there was a prior study which had significant central events to diagnose central sleep apnea.

An apnea diagnosis is typically based off of the diagnostic study (no xPAP). The only exception I'm aware of is if the titration study changes the diagnosis from Obstructive to Complex sleep apnea (centrals only appear in significant numbers once xPAP was added). It looks like you had (at least primarily) centrals to begin with.

If the diagnostic study led to the diagnosis of central apnea, even if there ended up being no central apneas during the study with xPAP, the initial diagnosis would still stand (the centrals are just being prevented/treated). If you didn't have a new diagnostic study recently, then I'd guess they were referencing your initial diagnosis from the study without xPAP, as a purely titration study cannot really re-confirm apnea, as they begin with pressure. Best wishes.

[theoldman22]

Thank you for the replies. I sent what I thought (hoped!) would be pertinent to my question.The total report has 2 pages of summaries and conclusions, 3 pages of tabulated data, and 2 pages of graphs.

I am enclosing one more set of data.
---------- 9

Therapy I Duration (min.) I Respiratory I Oximetry
(Ofo)
Cm Details Total REM NRE Sup. Apnea Hypop RER AHI RDI Arousa Mea Mi
H2O M Sleep CIOI I A I n n
M Central Index
0 0.0 0.0 0.0 0.0 N/A N/A N/A N/A N/A N/A N/A N/A
10/8 Full Face 33.9 0.0 33.9 33.9 0/1/0 0/0 0 1.8 1.8 0.0 92 90
Mask
11/8 14.8 0.0 14.8 14.8 0/0/0 1/0 2 4.1 12.2 12.2 93 92
12/1 23.9 17.0 6.9 23.9 0/0/0 0/0 3 0.0 7.5 7.5 93 92
0
13/1 2.6 0.0 2.6 2.6 0/0/0 0/0 0 0.0 0.0 23.0 94 93
1
10/8 20.0 0.0 20.0 20.0 0/0/0 0/0 3 0.0 9.0 9.0 93 93
11/9 17.4 0.0 17.4 17.4 0/0/0 0/0 6 0.0 20.7 20.7 93 93
12/1 13.8 0.0 13.8 13.8 0/0/0 0/0 5 0.0 21.7 21.7 93 93
0
13/1 5.3 0.0 5.3 5.3 0/0/0 0/0 7 0.0 78.8 78.8 94 93
1
14/1 15.3 0.0 15.3 15.3 0/0/0 0/0 6 0.0 23.6 31.4 94 93
2
10/8 108.0 28.5 79.5 96.7 0/1/0 8/0 11 5.0 11.1 8.9 91 89

[theoldman22]

Data did not come thjru. Will try again

[theoldman22]

Hope this comes thru.