Apnea type detection on AirSense 10

The AirSense 10 is supposed to distinguish between OSA and CSA events. Anyone could tell me how accurate it is?
We are using it for my son. The home sleep study showed half osa and half csa. Sometimes he takes a deep breath and then pauses, I always assumed that’s how the CSA events look like. The machine, however starts pumping the pressure up and records these events as obstructive.
Can I trust the machine here?

sunnyU wrote: ↑

Wed Feb 19, 2020 11:23 pm

The AirSense 10 is supposed to distinguish between OSA and CSA events. Anyone could tell me how accurate it is?
We are using it for my son. The home sleep study showed half osa and half csa. Sometimes he takes a deep breath and then pauses, I always assumed that’s how the CSA events look like. The machine, however starts pumping the pressure up and records these events as obstructive.
Can I trust the machine here?

Yes.

https://www.youtube.com/watch?v=4GW97Xk06N8

palerider wrote: ↑

Wed Feb 19, 2020 11:53 pm

Yes.

https://www.youtube.com/watch?v=4GW97Xk06N8

Thank you! It’s very interesting! Do you know if any studies were done to verify the accuracy of these machines?

sunnyU wrote: ↑

Thu Feb 20, 2020 12:17 am

palerider wrote: ↑

Wed Feb 19, 2020 11:53 pm

Yes.

https://www.youtube.com/watch?v=4GW97Xk06N8

Thank you! It’s very interesting! Do you know if any studies were done to verify the accuracy of these machines?

Are you suggesting that all these manufacturers just whipped up something and threw it on the market... without FDA approval, or ... anything, and they're experimenting on us?

TONS of studies, and patents.

sunnyU wrote: ↑

Wed Feb 19, 2020 11:23 pm

The AirSense 10 is supposed to distinguish between OSA and CSA events. Anyone could tell me how accurate it is?
We are using it for my son. The home sleep study showed half osa and half csa. Sometimes he takes a deep breath and then pauses, I always assumed that’s how the CSA events look like

What's more important that is what happens *after* he starts holding his breath. Does he just lie there peacefully? does he resume breathing normally (like if you just hold your breath for 10 seconds, then start breathing again, that's a central apnea.

Or does he take a recovery breath and maybe move around a little?

One can hold one's breath and, depending on how one is doing so, the airway may be open, or closed, all the machine can detect is whether it's open, or closed, and respond accordingly (not responding if it's open, responding if it's closed.

What does the data say?

palerider wrote: ↑

Thu Feb 20, 2020 12:37 am

What's more important that is what happens *after* he starts holding his breath. Does he just lie there peacefully? does he resume breathing normally (like if you just hold your breath for 10 seconds, then start breathing again, that's a central apnea.

Or does he take a recovery breath and maybe move around a little?

One can hold one's breath and depending on how one is doing so, the airway may be open, or closed, all the machine can detect is whether it's open, or closed, and respond accordingly (not responding if it's open, responding if it's closed.

What does the data say?

He does make a recovery breath after and occasionally moves. Does it make it obstructive? I’m just trying to understand what is going on with his breathing . The data on the cpap records everything as the osa, and our home study showed half osa half csa. We did not have a proper hospital study as the waiting list is a year long.

sunnyU wrote: ↑

Thu Feb 20, 2020 2:07 am

He does make a recovery breath after and occasionally moves. Does it make it obstructive? I’m just trying to understand what is going on with his breathing . The data on the cpap records everything as the osa, and our home study showed half osa half csa. We did not have a proper hospital study as the waiting list is a year long.

Recovery breaths and movement typically mean that it was an obstuctive, there's no need for a recovery breath with a central, because there's nothing to recover from.

It would help of you'd fill out the equipment profile, and post some charts!

http://cpaptalk.com/wiki/index.php/Oscar:organize

Forget the home study, sleep varies from hour to hour and night to night, all the home study is good for in indicating that he has a problem.

Often flow limitations will occur just before the large inhale and cause a pressure increase. The flow limits may cause the larger inhale, in turn the large inhale may cause the CA as you become temporarily over vented. This all may appear to correlate with the CA, but is not caused by it.
That's just a guess, but it would be best to see the OSCAR charts to see what's actually happening.

I disagree with palerider, the machine detection is not particularly accurate, however the Resmed detection is a lot more accurate than the Dreamstation's.
The accuracy also drops quite a bit as leaks increase.
The tech used was the best available at the time of the FDA approvals process, which is really, really old in tech world.

sunnyU wrote: ↑

Thu Feb 20, 2020 2:07 am

The data on the cpap records everything as the osa, and our home study showed half osa half csa.

What is his AHI on the CPAP and in the home study?

SleepyPaolo wrote: ↑

Thu Feb 20, 2020 4:18 pm

I disagree with palerider, the machine detection is not particularly accurate,

Lab studies indicate a high correlation with polysomnograms.

Back when the ResMed S9 was first released (first model to offer separate categories for central and obstructive apneas) I read a paper or study done where the S9 scored data was directly compared to an in lab human scoring and the results were quite decent.
90 to 95% of the time the machine and the human agreed with each other.

Where the machine has some trouble is the irregular breathing that we have while awake that the machine mistakes for some sort of airway issue. The machine's can't know sleep status...they don't know if we are awake or asleep. Obviously a human tech in a sleep lab with EEG sensors can tell if we are asleep or not.
So the machine might flag an awake irregularity in breathing as some sort of apnea event (commonly central but it can happen with OAs and hyponeas as well) and the tech would know that the person isn't asleep so no flag because you have to be asleep for it to matter.

What you might do is learn how to figure out awake/arousal related flagging from asleep flagging.
http://freecpapadvice.com/sleepyhead-free-software
This refers to SleepyHead but OSCAR is based off SleepyHead so all the instructions still work.
See if your son's machine is maybe flagging arousal breathing because it simply doesn't know if someone is asleep or not.
That's really the main limitation of the machine. Sometimes our awake breathing just confuses the machine.

I see it all the time...my AHI is almost always 80% arousal related false positives. Doesn't surprise me as I know I do a lot of tossing and turning and I always remember probably at least a half a dozen wake ups (which means I probably had at least that many that I don't remember) because of some pain issues with my back and pelvis. I have seen the machine flag and respond to OAs that were so obviously arousal related that a blind person could see it.
Nothing can be done about it though and my dream machine would be a machine that can better determine sleep or awake status so it could disregard awake breathing related irregularities.

Take some time to install OSCAR
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
and watch those videos and play around with zooming in on the flow rate and see if it looks like a real asleep event being flagged or if it is maybe a false positive.

Might ease your mind a bit to know that some of the flagged stuff isn't sleep related and we really just have to ignore the awake/arousal related stuff.
If there is an awful lot of awake looking stuff might try to figure out how to help him sleep more soundly but that's hard to do as an adult much less have a child help you figure it out.

You might also find that the bulk of anything flagged is right near a known awake time...like right at the beginning of the night or the end...and of course those can just be ignored.

palerider wrote: ↑

Thu Feb 20, 2020 5:21 pm

SleepyPaolo wrote: ↑

Thu Feb 20, 2020 4:18 pm

I disagree with palerider, the machine detection is not particularly accurate,

Lab studies indicate a high correlation with polysomnograms.

Resmed's is quite good, if we disregard inaccuracies associated with SWJ.
Phillips' is quite funny at times, it has to be less than 70% accurate. To dial in my Dreamstation I completely disregard it's reporting and look at the flow graph. Mine is now set up pretty much as a straight CPAP because it's event detection and auto functions are so bad that they cause me more problems than no CPAP at all.

If you watch the Lankylefty's channel, he has a video looking at machine data (I'm not sure which machine) and flow rate graph and he disregards most of the marked events. He is a PSG tech (or at least he claims to be).

Many pharmaceuticals are no more effective than a sugar pill. I don't hold much value in FDA trials, it's about $$, not efficacy and precision. Put 'em through and engineering ran lab test and let's see!!