what are Central Apneas?

can anyone tell me what are centrals listed as?
During B's sleep study he had 22 apnoeas - 11 obstructive, 5 mixed and 6 cental but when reading the report from Encore Viewer there are NR non responsive, FL flow limitation, OA obstructive apneas, H - hypopnea and VS Vibratory Snore. So how do I know if he is having Centals?
I've tried to put the reports on photobucket but am having no luck. I can get them to attach to an email so is there a 'wonderful' person out there that would let me email them with the reports and my daily report on settings and stuff that could look at the reports and advise my what I should change now, and how to know if the centrals are still happening?
We go to the sleep doc mid November , 3 hours away. Should I copy the reports , if so which pages, to take with me rather than handing over the machine?
Help would be greatly appreciated.
Bev

BarBe wrote:can anyone tell me what are centrals listed as?
During B's sleep study he had 22 apnoeas - 11 obstructive, 5 mixed and 6 cental but when reading the report from Encore Viewer there are NR non responsive, FL flow limitation, OA obstructive apneas, H - hypopnea and VS Vibratory Snore. So how do I know if he is having Centals?
I've tried to put the reports on photobucket but am having no luck. I can get them to attach to an email so is there a 'wonderful' person out there that would let me email them with the reports and my daily report on settings and stuff that could look at the reports and advise my what I should change now, and how to know if the centrals are still happening?
We go to the sleep doc mid November , 3 hours away. Should I copy the reports , if so which pages, to take with me rather than handing over the machine?
Help would be greatly appreciated.
Bev

Never hand over the machine and be very reluctant to hand over the smart card. If you have Encore Viewer, a printed copy (or printed to a .pdf file e-mailed to them) of the report(s) should be sufficient.

But, it depends on the pressure settings on the machine and how long of a duration the centrals/mixed may be. They're either going to show up as Obstructive Apneas or Non-Responsive.....the machine can't differentiate from airflow alone. If they're short in duration they would probably not be a significant problem. If the machine's maximum pressure is set too high and there are apneas occurring at higher pressures, they could possibly be pressure-induced Centrals. If the Apnea "tics" on the report are appearing in clusters, they might be Centrals. If there are Apnea "tics" listed on the report and the pressure made about 3 pressure increases.....and then dropped pressure.....that would be an indication of a Non-Responsive (where it wasn't able to clear the apnea and then backed off).
Pressure settings are important when treating patients with Centrals......finding the proper range.....not too low and not too high.

Den

Would Central Apneas appear on Encore Viewer reports as NRs ( non-responsive apneas)? I wasn't clear about that in your reply, Wulfman.
Thanks

Hawthorne wrote:Would Central Apneas appear on Encore Viewer reports as NRs ( non-responsive apneas)? I wasn't clear about that in your reply, Wulfman.
Thanks

The definition of Non-Responsive events can be found here on Respironics' site.

http://sleepapnea.respironics.com/techn ... logic.aspx

But, as to how they would appear on the report, it would depend on the duration of the event and however the machine interprets the event. If the Central is short in duration and the machine logic interprets the events as being cleared, then it would not score it as a Non-Responsive.....only as an Obstructive Apnea.

Den

Thanks Wulfman! I have had only one NR show up in 9 months of data reports. It was a surprise! You reminded me of it in this thread so thought I would ask.

I appreciate your reply and saving me a search which I should have done!

On a Encore report, centrals can show up as:

Obstructive Apnea
Hypopnea
NR or NRAH (Non-Responsive Apnea/Hypopnea)

The machine is flow-based, it cannot tell the difference from a 40 second obstructive apnea (like your tongue falling into the back of the throat and blocking the airway) and a 40 second central apnea (simply stopping breathing, breathing shallow etc.).

When a "NR" or NRAH shows up on the Encore report, know that it takes a total of 6 events and 3 pressure increases for that flag to show up, it's a long time. Once it does show up, it locks out that algorithm for 15 minutes.

If you have patterns of clusters on your report in the event section, those OA tics can be a combination of both obstructive and central events.

Best you can do is adjust pressure to obtain the lowest AHI, because if centrals are included in that count the lower the AHI the lower the number of centrals you experienced. IF AHI climbs as pressure increases that means the pressure is causing more centrals to show up because centrals don't usually respond to pressure increases. In that case you would have to lower the pressure.

Risk of centrals showing up is generally lower staying below 10 cm pressure. Best way to find your ideal pressure is plotting the pressure and AHI together going from low to high.

Thank you too Snoredog. I only every had the one NR appear in 9 months of using Encore Viewer. I have an auto range set narrow (10.5cm-13cm). My AHI is almost always below 1. That one NR was a surprise to me. I had almost forgotten about it until centrals were raised in this thread.

Hi Wulfman, Snoredog and Hawthorne
thanks for your replies.
So if I'm reading this right NR's could be Centrals and could be pressure based - which I don't think it's pressure based as there has been NR's at 11, 10 , 9 & 4. Although not a great number they're there every so often.
As to OA's they vary from 0 to 6.4 ( only once) There has only been a couple of reports that have shown the OA's as a thick group.
I had never thought about centrals until after reading the forum the advice was always to get a copy of the initial sleep report - I did that and read it, now the questions begin.
I asked for a copy of the study when he was titrated or tiltrated or whatever it is but haven't got one yet.
I am increasing the pressure of B's machine as I follow the advice given to others here.
Just when I think things are not going well B has a good report ( well, better than he was having), and vice versa.


Hawthorne I have emailed you - I hope this has been done right.
Thanks again for the replies. They have been very helpful in my quest for more knowlege.
Bev