Clear Airway Apnea = Central Apnea?

quirk? I resemble that -- bye bye deer -

Rebecca R wrote:

dsm wrote: The best approach is to watch & smile. What one might see is what happens when very smart minds get access to public forums Each of those personalities has a lot to offer, just gets confusing when they talk to each other

RestedGal summed it all up very well with her comment 'quirky sense of humour'

DSM

Oh Thank Goodness...now I don't have to go find a silent leaf blower and a loud speaker. Not to mention researching things like FOT, subatmospheric intraluminal pressure, Weinman....and where to find a fiber-optic nasopharyngoscopy device to measure my pharyngeal occlusion. What the heck, I think I'll look up that Weinman guy anyway.

I think "quirky" could be an understatement perhaps?

r

Rebecca,

But that line of stuff was from SWS & myself looking at FOT

************************************************************************************

The below is me offering my perspective - it may or may not match other folks views ...

Reason FOT is such a topic among us is that there has been a debate 'raging' ? for some time (years) over what technique is best and simplest to determine if an apnea is obstructive (OSA) or a central (CA). FOT was devised as a method of sending a low frequency pulse into the airtube & sampling what came back & using that analysis to determine if the patients airway was open or closed thus a central or an apnea. The two get treated very differently in terms of pressure reaction by the machine.

FOT was a technique tried by several compnies over recent years (resmed, Weinmann, Respironics to name the main few).

Weinmann (Germany) were possibly the 1st company to come to market with a machine that claimed to employ FOT even if the other companies had earlier prototypes that they never released. This was the Weinmann SOMMNOSmart (a bilevel).

In recent times ASV machines have taken off as a broad spectrum solution for a wide variety of sleep complications & Weinmann in Germany may have been the 1st to employ FOT (although SWS believes justifiably that they dropped it ) in an ASV machine that they call the SOMMNOVent CR. FOT is used to detect if an apnea was obstructive or central, but their literature no longer mentions FOT (which reinforces SWS's belief that they employed some other technique). The ability to 'accurately' determine the difference between a central & obstructive apnea as a 'holy grail' of cpap therapy as it requires some very fancy technology to ensure the required accuracy.

Some people argue that the only definite way to make such a determination (I believe Muffy & team support this view) is with attachments that measure abdominal effort to breathe as that is the final arbiter as to what the patient is going through. Muffy has added several significant comments over time on this topic & knows the matter well. Muffy runs a sleep study center & thus has a lot of authority (even if different people claim to run that same sleep center ). Lets consider Muffy is the boss for now.

But with Weinmann having come to market with 1st a bilevel & now an ASV machine that both claim to be able to accurately make an accurate ca vs osa apnea determination, there is a lot of activity now occuring from other vendors. Weinmann don't currently sell into the US market (no FDA approvals applied for that we know of) so the race has been on between Resmed & Respironics to grab this space & claim they have the technology that can accurately detect central vs obstruction.

Why does it matter ? - well this is a massive & growing market & most manufacturers are trying to keep 1 step ahead. The ideal machine is a completely self-titrating machine that caters for all the possibilities & oddities of Sleep Disordered Breathing - that is another 'holy grail' but we are inching towards such a capability. The reality is that the market can take basic + 'plus' model machines for some time & thus the multi-purpose machine holy grail is not quite needed at this time, just market share

So in summary there is a three way debate taking place ...
1) No FOT or other similar home machine technique can truly determine if an apnea is OSA or CA
2) FOT can do it but perhaps to a specified level of accuracy that is under 100%
3) Some other technique than FOT can do it (or is being claimed to be doing it)

Either way, the main vendors are all talking up their ability to detect CA vs OSA apneas & thus are adding more capability to their machines claiming such is the case.

Hope this summary helps clarify some of our rambling exchanges ...

DSM

another_guest wrote:quirk? I resemble that -- bye bye deer -

Yes I was about to add that Captain Quirk commanded the greatest & most famous starship we know of.
A name to respect.

DSM

dsm wrote:although SWS believes justifiably that they dropped it

Mr. Google says that Weinmann didn't drop FOT.
http://www.google.com/search?hl=en&clie ... =&aqi=&oq=
Weinmann's proprietary term is OPS (oscillatory pressure signal) and they have current models that employ that FOT (OPS).

dsm wrote: So in summary there is a three way debate taking place ...
1) No FOT or other similar home machine technique can truly determine if an apnea is OSA or CA
2) FOT can do it but perhaps to a specified level of accuracy that is under 100%
3) Some other technique than FOT can do it (or is being claimed to be doing it)

Did I once again completely miss that a "debate" was taking place?

-SWS wrote:

dsm wrote:although SWS believes justifiably that they dropped it

Mr. Google says that Weinmann didn't drop FOT.
http://www.google.com/search?hl=en&clie ... =&aqi=&oq=
Weinmann's proprietary term is OPS (oscillatory pressure signal) and they have current models that employ that FOT (OPS).

dsm wrote: So in summary there is a three way debate taking place ...
1) No FOT or other similar home machine technique can truly determine if an apnea is OSA or CA
2) FOT can do it but perhaps to a specified level of accuracy that is under 100%
3) Some other technique than FOT can do it (or is being claimed to be doing it)

Did I once again completely miss that a "debate" was taking place?

Well, some poetic license may be needed - are you willing to grant it

DSM

Well, Mr. Google says that the verb "deliberate" is a synonym for "debate". So I guess on that basis you may have a weekend fishing license...

so are you fishing / trolling for fake sharks in legality of clinical manual threads?

another_guest wrote:so are you fishing / trolling for fake sharks in legality of clinical manual threads?

LOL !

DSM

Oh, THAT...

Also I just spotted that nice T-shirt, Captain!

Given the suspected need for xPAPs worldwide, the race for market share is to be expected. The interesting thing is what percentage of folks have plain jane SA requiring a basic machine (however we define that) and what percentage have more challenging SDB and require a more complex machine. In my case, starting out obese and then losing wt created larger airways that need less pressure to stent open...that should have identified in the beginning as a therapeutic goal (then explained to me) and an APAP prescribed with instructions to self-titrate after the loss of x #s and a sleep study after the loss of y #s. It sure would have helped me understand my situation and the goal; as it was, I was terrified of dieing and after my PSG wanted the equipment just because I slept so well, keeping me alive during sleep was primary and sleeping well was just a notch under in importance. I never really got it that losing wt might make my airways larger, hence losing therapy air via lip puffs was not a concept I had until I joined here and started posting. God only knows how those with complex SDB are educated and the goal of treatment explained...we need much better user education programs that's for sure!

With the release of the new S8 Escape II which is an APAP, it will be interesting to see what the mfgs do with these devices esp given knowledgeable users demanding access to more and more easily accessed data (and why don't they store a yr's worth of detailed data, memory is cheap)...the industry seems poised on the edge of an 'industrial' revolution. But an all in one xPAP? Maybe blue sky at this point but headed in the right direction for sure.

but obama care won't allow any perks I bet and if the government won't allow it then will the lowly other insurance plans?


now -SWS get back to work to get my damn medical bills paid from all the neuro stuff this summer - your state is very delinquent on paying things except I did get my token raise yesterday

dsm wrote:
Hope this summary helps clarify some of our rambling exchanges ...

DSM

Well when you put it that way, it makes perfect sense. Thank you for putting it in the right order and explaining, because it really does make sense now.

I was quite entertained even before I understood it. (Yes I know...another sleep deprived Newbie ). What will I do when I catch up on my sleep and have to actually understand things to entertain myself.

Now that I know there is going to be a "holy grail" machine, I won't be happy until I get one.

r

another_guest wrote:but obama care won't allow any perks I bet and if the government won't allow it then will the lowly other insurance plans?


now -SWS get back to work to get my damn medical bills paid from all the neuro stuff this summer - your state is very delinquent on paying things except I did get my token raise yesterday

Oh, you just intentionally gave me those dead-giveaway clues along with that avatar location!

Nice one!

well this is my original cpaptalk name - I did many posts as a guest. I understand that SAG / Muffy et al used my name (as we had run into each other at that other place) and became still another guest here once guest were not allowed to post links (he had also many posts as a guest).


Yeah Location is everything and well that location has been on my profile since the start over 4 years ago.

So no I am not that multiple personality sleep center guy - I am just a lowly dual personality cpaptalk poster who normally uses another name here.

another_guest wrote:well this is my original cpaptalk name - I did many posts as a guest. I understand that SAG / Muffy et al used my name (as we had run into each other at that other place) and became still another guest here once guest were not allowed to post links (he had also many posts as a guest).


Yeah Location is everything and well that location has been on my profile since the start over 4 years ago.

So no I am not that multiple personality sleep center guy - I am just a lowly dual personality cpaptalk poster who normally uses another name here.

I noted that WA loc ref & guessed this was a sep person but - SWS knows for sure

DSM