Interpreting My Report--Snoredog or Slinky--or anyone else..

Velbor wrote:. . . thoughtful and caring reflections on my anomalous data . . .

Some have trouble in REM; some have trouble in NREM SWS stage 4.

I'm not sure either case would be an anomaly, would it?

All sleep is a stage. And all the men and women merely sleepers:
They have their apneas and their hypopneas.
And one man, in his time of sleep, plays many parts.

--Shakespeare on the Hose.

Mothers!!! I certainly remember hearing "bass ackwards" more than a few times whilst growing up!!!

So, SWS? You can detect between "pallet saggers" and passive "tongue sliders" during a sleep evaluation? Or how do you determine one from the other?

Slinky wrote: Would a recent spirometry result tell you anything? I haven't had a full PFT in a couple of years but I've had 3 spirometries the last 9 months and have those printouts.

Slinky, hypercapnic COPD entails too much CO2 blood-gas retention. So I think your pulmo would ultimately want CO2 measured if there was reason to suspect hypercapnic COPD.

jnk wrote: Some have trouble in REM; some have trouble in NREM SWS stage 4.

I agree that there should be a wide variety of sleep event distributions across our SDB patient population. Some will have trouble in the early stages of sleep as well. As a group we're diversely SDB-anomalous compared to the general population.

All sleep is a stage. And all the men and women merely sleepers:
They have their apneas and their hypopneas.
And one man, in his time of sleep, plays many parts.

--Shakespeare on the Hose.

Say, didn't he also write "A Midsummer Night's REM Adventure" or some such sleep-related comedy?

Ah, yeah, SWS, thanks. Last I knew I was not yet a "C02 retainer". I understand that PCO2 of a PFT is what indicates C02 retention?

I had a six minute walk/immediate ABG w/in 20 seconds (doctor ordered), actually 27 seconds (RT decided that was good enough for the doctor I go with) about 18 months/2 years ago. The previous ABG w/o the six minute walk was about 12 years ago. NEITHER of which was painful as so many people claim. Mine felt no different than a regular blood draw despite being drawn from wrist w/the myriad nerves in such close proximity.

Slinky wrote:Mothers!!! I certainly remember hearing "bass ackwards" more than a few times whilst growing up!!!

My mother never said that, but she did on a few occasions wish me that "I hope your kids give you just as much trouble as you're giving me"

Slinky wrote: So, SWS? You can detect between "pallet saggers" and passive "tongue sliders" during a sleep evaluation? Or how do you determine one from the other?

As for the second comment -- SWS yes please I would really like more info on these various types of apnea causes. According to my sleep doc I am more the case of the second - ie. my airway is narrow to begin with and I have a receding chin -- I never thought about the implications of that on my OSA. Except that all the sleep doc would say on that was that it just made it more likely that my tongue would get lodged in my throat. I don't think i have the 'sagging pallet' ? My tonsils were removed as a kid and they also contemplated removing my "nose meat" (literal translation from Turkish - i have no idea what the English equivalent is!).

I also haven't noticed my events as being clustered or otherwise, because my AHI has always been low (it's the flow limitation runs that I'm still trying to resolve - and the less there are the better I seem to feel.) I still need to ask for my PSG so I don't know the situation during sleep without CPAP.

Are the 'airway physics' somehow different in one case versus the other? That is, does CPAP have more or less tendency to resolve one obstruction vs. the other??

Do you have any literature on this?
Thanks!!

Slinky wrote:I had a six minute walk/immediate ABG w/in 20 seconds (doctor ordered), actually 27 seconds (RT decided that was good enough for the doctor I go with) about 18 months/2 years ago. The previous ABG w/o the six minute walk was about 12 years ago. NEITHER of which was painful as so many people claim. Mine felt no different than a regular blood draw despite being drawn from wrist w/the myriad nerves in such close proximity.

ohhh i had that done too! It didn't hurt, but it just felt strange.

Slinky wrote:You can detect between "pallet saggers" and passive "tongue sliders" during a sleep evaluation? Or how do you determine one from the other?

Slinky, my understanding is that today's typical PSG methodology cannot differentiate the various mechanics of airway obstruction.

But doctors will typically try to screen for typical nose, pharyngeal, and craniofacial characteristics associated with sleep disordered breathing. I think that type of physical evaluation is also used to help assess likely treatment options.

echo wrote: As for the second comment -- SWS yes please I would really like more info on these various types of apnea causes. According to my sleep doc I am more the case of the second - ie. my airway is narrow to begin with and I have a receding chin -- I never thought about the implications of that on my OSA. Except that all the sleep doc would say on that was that it just made it more likely that my tongue would get lodged in my throat. I don't think i have the 'sagging pallet' ?

My wild hunch is that many of us possess some combination of common airway-closure related mechanics. However, I also think some of us probably possess one trait or another as being most salient in the makeup of our own somewhat unique airway-closure dynamics.

echo wrote:Are the 'airway physics' somehow different in one case versus the other? That is, does CPAP have more or less tendency to resolve one obstruction vs. the other??

The physics of airflow are going to be pretty much the same (Google either "apnea" or "flow limitation" together with "Starling resisitor" model). Essentially the dynamics of pressure, flow, and airway resistance through a collapsible tube (or pharynx) will behave very similar, regardless of how that increase in airway impedance occurs. The physical mechanics of airway closure or partial airway closure are specifically what change. Generally those "elastic" airway closures tend to resolve nicely with airway inflation or pressurized airway "stenting". But in some cases, such as Velbor's, moving the mandible forward (via dental splint or surgery) seem to help more than using CPAP. I think Velbor's results may simply be a function of forward mandible travel yielding more airway clearance than airway inflation can possibly yield (probably at some relatively inelastic or less-elastic point of airway occlusion in Velbor's case). There are yet other nasal/pharyngeal/craniofacial surgical options that don't always work so well.

echo wrote: Do you have any literature on this?

Sorry, I'm not a very good literature/link collector. Here's one interesting and semi-relevant link that I just now gathered:
http://pats.atsjournals.org/cgi/content/full/5/2/136 (see section on Craniofacial Anatomy as well as relevant footnotes)

echo wrote:Location: 1060 W Addison St # 1, Chicago

GO CUBS!

Three sleep docs thru the years and nary a one has ever looked in my mouth! But, hey, I had NO sleep problems until after a whiplash in early '94 so I doubt I have any "structural" problems other than a slightly deviated septum. And I'm not so sure I always had that. I suspect an awning support on the RV that landed right across my snozz and caused me to black out and then walk around for days w/"raccoon eyes" did a number on the septum.

-sws wrote:

echo wrote:Location: 1060 W Addison St # 1, Chicago

GO CUBS!

Great address if you wanna live in the PROJECTS!!

Try moving up to a high-class neighborhood:

123-01 Roosevelt Avenue
Flushing, NY 11368

SAG

StillAnotherGuest wrote:

-sws wrote:

echo wrote:Location: 1060 W Addison St # 1, Chicago

GO CUBS!

Great address if you wanna live in the PROJECTS!!

Try moving up to a high-class neighborhood:

123-01 Roosevelt Avenue
Flushing, NY 11368

SAG

LOL. When was the last time they won a world series?

echo wrote:LOL. When was the last time they won a world series?

Was? SAG does not do "was" (he doesn't even have a rear-view mirror in his car. He don't care where he's been, only where he's going.)

The "last time" is irrelevant. The "next time" is 2008.

SAG

StillAnotherGuest wrote:

echo wrote:LOL. When was the last time they won a world series?

Was? SAG does not do "was" (he doesn't even have a rear-view mirror in his car. He don't care where he's been, only where he's going.)

The "last time" is irrelevant. The "next time" is 2008.

SAG

...Both comments.

slinky wrote:Ah, yeah, SWS, thanks. Last I knew I was not yet a "C02 retainer". I understand that PCO2 of a PFT is what indicates C02 retention?

Slinky, that sounds right to me. I think the typical diagnostic sequence for recognizing hypercapnic onset in SDB-related COPD might go something like this: 1) PCO2 routinely measured during daytime PFT, 2) if PCO2 returns positive for hypercapnia, then a PSG should be ordered to monitor CO2 retention during sleep, 3) changes to sleep therapy may be required to address the initial hypercapnic component of COPD during sleep, and 4) periodic follow-up PSGs are ordered with CO2 monitoring to address any changes in hypercapnia or other COPD-related changes impacting sleep disordered breathing.

Hoping SAG will comment if the above is not the "usual" clinical sequence for recognizing hypercapnic onset in COPD-related SDB. I suppose the alternative is that a clinic or sleep center might proactively monitor for CO2 retention during a COPD-related PSG---even before the daytime PFT shows significant signs of hypercapnia. I suppose in that last scenario a clinic would be proactively "fishing" for the onset of that hypercapnic component during sleep. Wonder how insurance companies would take to that kind of hypercapnic fishing. Me thinks they would try to cut the fishing line.

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skjansen wrote:This is to snoredog or slinky or anyone else that may be able to provide some input. Here are my numbers from last night:

I'm sorry about sidetracking your thread, skjansen. That happens a lot around here. Just wondering if your had any more info, comments, or questions to throw in for Snoredog, Slinky, and the rest of the gang.

StillAnotherGuest wrote:Was? SAG does not do "was" (he doesn't even have a rear-view mirror in his car. He don't care where he's been, only where he's going.)

The "last time" is irrelevant. The "next time" is 2008.

SAG, that's so zen.... so Yoda.... I like it ooooooouuuhhhhhhmmmmmmmmmmmmm


(skjansen -- sorry for hijacking the thread, again!!!!)

-SWS wrote:

slinky wrote:Ah, yeah, SWS, thanks. Last I knew I was not yet a "C02 retainer". I understand that PCO2 of a PFT is what indicates C02 retention?

Slinky, that sounds right to me. I think the typical diagnostic sequence for recognizing hypercapnic onset in SDB-related COPD might go something like this: 1) PCO2 routinely measured during daytime PFT, 2) if PCO2 returns positive for hypercapnia, then a PSG should be ordered to monitor CO2 retention during sleep, 3) changes to sleep therapy may be required to address the initial hypercapnic component of COPD during sleep, and 4) periodic follow-up PSGs are ordered with CO2 monitoring to address any changes in hypercapnia or other COPD-related changes impacting sleep disordered breathing.

LOL! Well, if this don't jack this thread outta sight, then I don't know what would!

Anyway, shouldn't we really be talking about RBIs instead of RDIs? And ERA instead OSA?

Assessment of pCO2 in COPD is done only via arterial blood gas, and ABG is indicated only in the presence of moderate to severe disease vs "routine".
The first indication of CO2 retention often occurs when the patient comes into the ED acutely decompensated.
PSG is not indicated for the diagnosis and/or management of CO2 retention, but if there is concurrent SDB with COPD ("Overlap Syndrome") then PSG becomes appropriate.
The routine use of NIPPV in chronic respiratory failure is not generally indicated.
You can search for 3-letter words by adding a "search character" (like * or +) that will allow you to look for important terms like REM, RDI and a couple others which escape me right now.
This guy sure looks like an OSA candidate, don't he?



SAG