Central apneas, periodic breathing increase after stent and medication

I've used a Bipap machine very successfully for over 15 years. (May, 2018 through June, 2022, AHI average of less than 2.0. Clear Airway level for the 10 months through June, 2022 was .32, with the highest rating being .43).
On July 2, I began taking 2.5 mg of Bisoprolol Fumarate and 10 mg Pravastatin, and saw much fluctuation and some increase (AHI average of 4.6 for 15 days, but 4 of those days with a level higher than 8.0). Thinking that increased pressure would improve central apneas, as well as obstructive, and not realizing that higher pressure could increase centrals, I requested that my doctor increase my IPAP and EPAP levels. He raised the IPAP level from 11 to 12, but left the EPAP at 8. It did not occur to me at that time that the changes I was experiencing might be from one of the new medications. However, I've since learned that Bisoprolol is contraindicated for someone with a slow heartbeat, which I have.
The higher IPAP helped some until July 25, when I had a cardiac cath with a stent placement and began 75 mg of Clopidogrel (Plavix). For the rest of July, I saw an AHI average of 7.98 with a 3.64 clear airway level. (This did not include the 22.19 AHI, 15.07 clear airway, or 30.69% periodic breathing for the first night following the procedure.) From August 1 through August 10, AHI has averaged 6.87, and clear airway average has been 3.95. Periodic breathing used to be low, and now it's often up in the double digits. Is all of this typical after having this procedure and taking these medications? In looking at the flow chart, I realize that I can't tell the difference between periodic breathing and Cheyne-Stokes. Please advise as to whether or not I may be having those. Would OSCAR be labeling these on what it reads from my Bipap? (I was still using Sleepyhead on August 7, but I've downloaded OSCAR now). Perhaps I would be wise to request that my doctor allow me to stop the Bisoprolol, at least until I'm finished taking the Plavix.
Thank you for your insights.



https://imgur.com/a/Ec7Wc29

CSR or Cheyne Stokes Respiration is a very specific type of Periodic Breathing.
Periodic Breathing is just a waxing and waning of the flow rate or breaths.
Not all Periodic Breathing equals CSR though.
OSCAR is only reporting what the machine itself is labeling something....so it's not OSCAR doing the labeling of anything.
It's your machine that is doing the labeling.

CSR that is real CSR has a very specific pattern and you have to zoom in on the breaths to see the pattern.
We can't tell from the big picture if your flagged CSR is real CSR or just Periodic Breathing.
This is what real CSR looks like. Very definitive pattern.



and this is what it looks like on an OSCAR report



Now this one below is plain ordinary Periodic Breathing. The machine still flags it because of the waxing and waning but it isn't real CSR and it means nothing and we just ignore it.



These machines always flag anything that looks remotely like CSR because CSR can be a warning signal for heart problems.
The idea is to at least bring this pattern of breathing to the attention of a doctor and let the doctor decide is the pattern shown is indicative of any problem that they aren't aware of that needs attention.
Better to be safe than sorry kind of thing.

Now your increase in the numbers of central apneas along with the flagging makes me really concerned that it is probably real CSR but then you add in your history....we already know you have heart issues and procedures and new meds which could also be a factor in this new situation with your machine. So with your history it doesn't surprise me but just to be extra careful I am going to suggest that you bring this to the attention of your doctor and let him decide if he wants to be worried or not or if he wants to maybe give it time and see if anything changes.

Could it be medication related? Sure it is very possible.
Could it be procedure related and general anesthesia related? Sure if is very possible.

This type of potential problem or just concern on your part is REALLY something you should be having a chat with your cardiologist about.

God gave us one heart...2 eyes and 2 ears....I don't waste much time when there is any sort of question about any of those organs. They are too important to not pay attention to something that is out of the ordinary.
While I am fairly certain the increase is related to medication or procedure I don't know how long it is expected to last or if the doctor is going to be concerned or not and he knows your full history....we here on this forum do not know your entire history nor are we doctors.

So I can explain what CSR looks like and with the central apneas also being flagged....It would not surprise me one bit if that is real CSR and anytime we see real CSR we advise people to bring it to their doctor's attention and let the doctor decide if it is something to worry about or not.
You do have a history of heart problems since you had the stent done and you are on heart medications....
So call your doctor tomorrow and see if he is concerned about this or not.

It's not unusual to have weird AHI numbers after any sort of surgery or procedure and if it had been anything other than a heart thing I would say "give it time" but in this situation I am not comfortable with the "give it time" advice.

Call your doctor.

Thank you for your advice. I'll get in touch with my cardiologist.
Were you able to glean any information from the image I posted on imgur, or do I need to stretch out the flow rate chart before sending the image?
How do I know how far to stretch it in order to be able to tell how long the breathing or apneas last?
And do I understand correctly that my machine, Respironics Dreamstation Auto Bipap (which did not appear to pop up with my question, even though I submitted the information), is not one which clearly tells whether or not it thinks it's Cheyne-Stokes, but just labels as CA?

CA Clear Airway Apnea or central apnea. The airway is open/clear but no air is moving because there is no effort to breathe.

PB on the top line is Periodic Breathing which is just the waxing and waning of the air flow/breaths.
CSR is a type of periodic breathing but not the only type. The machine flags ALL periodic breathing just to call attention to the fact that something is maybe going on with the breathing that needs further evaluation.

So you have 2 labels up there
PB and CA. You can have either without necessarily the other but when you have PA and CA/Centrals that is when we pay special attention to any flagged PB as it could very well be CSR.

You don't want to zoom in too much and you don't want to zoom out too much either.
Usually somewhere to a 3 to 5 minute segment of time in the middle of the green flagged flow rate is sufficient to get an idea if the pattern is CSR pattern or not.

When you call your doctor explain that your machine is reporting a lot of Periodic Breathing with a lot of central apneas along with it and your concern is Cheyne Stokes Respiration.
He may or may not ask to see a copy of the detailed report. He probably won't be familiar with OSCAR though but I can guarantee you that what OSCAR reports is going to mirror what Respironics Encore Pro software will show.

Here's a similar report from Encore Pro which is Respironics software from a different guy with CSR flagged PB.
It's the real deal.