A chart showing OSA effects - Part 1

dsm · Post by **dsm** » Wed Feb 10, 2010 9:20 pm

SWS

Many thanks for your in-depth explanation. When I read this

>>
mixed sleep apnea,

a condition marked by signs and symptoms of both central sleep apnea and obstructive sleep apnea.
It often begins as central sleep apnea and develops into the obstructive form. Mixed sleep apnea
may also result from obstructive sleep apnea as hypoxia and hypercapnia induce signs and symptoms
of the central form.
<<

I took it to mean what it said, but, as you point out there is a lot of ambiguity and I am happy to
accept your POV on this.

Once again we learn and once again thank you for your deep knowledge on this matter.

DSM

-SWS · Post by **-SWS** » Wed Feb 10, 2010 9:56 pm

Right. They're talking about a medical "condition" or overall presentation in that part you have outlined above---not a single clinical event.

By contrast, below you are clearly talking about a single clinical event and not an overall medical "condition":

dsm wrote: I said that 'Mixed Apnea' can be a central that becomes an obstruction or an obstruction that can become a central.

Are you saying that this is *not* the case ???. It is a pretty easy reply to make, yes or no !.

So above you are clearly referring to single mixed events---not multiple events. You then break the above single event into two scenarios : 1) a medically acknowledged singular clinical event that starts off central and then turns to obstructive, as well as 2) a much more hypothetical singular clinical event that would start off obstructive and then turn central.

You then cite three medical references to support that single hypothetical event type. Instead, your first medical reference supports that first medically acknowledged singular clinical event. The second and third medical references talk about an overall mixed "condition" instead of describing or supporting that hypothetical single-event mixed apnea that would start off obstructive.

That said, I don't doubt that across the populace single-event mixed apneas occasionally start off obstructive and then turn central as you hypothetically describe in the quote I have above. However, that has to be very rare compared to the other extremely well-documented single-event mixed apnea (central to obstructive in a single event).

dsm · Post by **dsm** » Wed Feb 10, 2010 10:11 pm

-SWS wrote:
<snip>

By contrast, below you are clearly talking about a single clinical event and not an overall medical "condition":
dsm wrote: I said that 'Mixed Apnea' can be a central that becomes an obstruction or an obstruction that can become a central.

Are you saying that this is *not* the case ???. It is a pretty easy reply to make, yes or no !.
So above you are clearly referring to single mixed events---not multiple events. You then break the above single event into two scenarios : 1) a medically acknowledged singular clinical event that starts off central and then turns to obstructive, as well as 2) a much more hypothetical singular clinical event that would start off obstructive and then turn central.

<snip>

I didn't think what I said was 'clearly' a single event situation ?

In fact in my original post I had the below words but I removed them as I thought it added ambiguity.

"The central following the obstruction does not necessarily follow immediately after the obstruction"

Also the example I included where the sleeper gasps & hyperventilates thus inducing hypocapnia & a central.
At that point I was 'clearly' talking of 2 events representing what you have described well as a 'condition'.

Further "an obstruction that can become a central" doesn't 'clearly' say a single-event ? - but as we have
agreed. Lots of ambiguity in the profession & picked up by us mortals.

But, as already stated, I accept your interpretation overall. I think 'condition' explained it as you said.

Thanks

DSM

-SWS · Post by **-SWS** » Wed Feb 10, 2010 10:57 pm

dsm wrote:Further "an obstruction that can become a central" doen't 'clearly' say a single-event ?

Well, if your statement "an obstruction that can become a central" referred to an entire sequence of multiple events rather than but one changing mixed event, then I suspect you were debating a different animal than ozij and rested gal had been discussing...

One is an entire breed of mixed lineage while the other is but a lonely mutt or several mutts howling in the night.

dsm · Post by **dsm** » Wed Feb 10, 2010 11:03 pm

-SWS wrote:
dsm wrote:Further "an obstruction that can become a central" doen't 'clearly' say a single-event ?
Well, if your statement "an obstruction that can become a central" referred to an entire sequence of multiple events rather than but one changing mixed event, then I suspect you were debating a different animal than ozij and rested gal had been discussing...

One is an entire breed of mixed lineage while the other is but a lonely mutt.

No no no no - I never mentioned a string of events - SWS I now think you are warping this ?

I saw a situation where an event pair was occurring. OSA in certain people then triggers an immediate (within seconds) CSA.
It seems entirely feasible to me & also I could see it fitting with a description of Mixed Apnea.

I had not seen any description of Mixed Apnea that 'clearly' stated that Mixed Apnea was a single event & my response very clearly shows this !.

You then raised the word 'condition' & I accepted that as a very adequate explanation.

ok

DSM

-SWS · Post by **-SWS** » Wed Feb 10, 2010 11:27 pm

dsm wrote:No no no no - I never mentioned a string of events

dsm wrote:I had not seen any description of Mixed Apnea that 'clearly' stated that Mixed Apnea was a single event & my response very clearly shows this !.

Well, now I'm confused about exactly WHAT you meant all along in the current thread when you repeatedly said "mixed apnea" starting with the Dr. Ahsan correction.

Were you referring to "mixed apnea" as:
1) a single event that begins central or obstructive before turning opposite before that same event's completion,
2) a single event that causes a followup opposite-type event (more than one SDB event),
3) an overall condition reflected by some central events and some obstructive events---sometimes even having single mixed events thrown in,
4) some combination of the above three items,
5) none of the above, but something altogether different

My comment was that the medical community used to refer to one (1) and three (3) above as "mixed apnea". But now they tend to refer to one (1) above as a "mixed apnea" and three (3) above as the general category known as "complex" disease.

Specifically the hypocapnic "complex disease" that entails a CPAP emergent central component is a subset of the overall term "complex disease". That CPAP-emergent "complex disease" is referred to as either "Complex Sleep Apnea" (hence CompSA or even CompSAS with the term "syndrome" appended) or even "Complex Sleep Disordered Breathing" (CSDB) depending on researcher/practitioner paradigm. There is also hypercapnic "complex disease" that is not the aforementioned CompSAS/CSDB.

However, in 2010 the medical profession tends not to label any of the conditions now known as "complex disease" with the term "mixed apnea" as they might have back in 1986. Regardless, some medical professionals still refer to "complex disease" by the term "mixed apnea" to this day---despite Gilmartin, et al's 2005 proposal. Gilmartin, et al tend to go with CSDB while Mayo and Medicare tend to go with CompSA or CompSAS when they are referring specifically to CPAP-emergent hypocapnic complex disease.

...At least that's my take. But there is clearly a LOT of ambiguity and lacking consensus in medical terminology to this day related to the terms "mixed" and "complex". That lacking terminology consensus within the medical profession is why I saw no problem with Dr. Ahsan's terminology that was later clarified in that same presentation.

So of the five, which have you been referring to all along as "Mixed Apnea"?

ozij wrote:The only way of arriving at a technical truth is by discussing it over and over, until the facts are clear.

Agreed.

dsm · Post by **dsm** » Thu Feb 11, 2010 12:11 am

Steve,

I already told you, I was referring in particular to this ...

MIXED SLEEP Apnea (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier).
"a condition marked by signs and symptoms of both central sleep apnea and obstructive sleep apnea.
It often begins as central sleep apnea and develops into the obstructive form. Mixed sleep apnea
may also result from obstructive sleep apnea as hypoxia and hypercapnia induce signs and symptoms
of the central form."

Now if this statement is incorrect we should contact the publisher & tell them to either
- remove it
- qualify it, or
- rewrite it

I am happy to follow through once we agree what it should be !

Cheers DSM

-SWS · Post by **-SWS** » Thu Feb 11, 2010 12:13 am

Can you help me out and assign that definition a one, two, three, four, or five----just to clear up my own confusion about your understanding of that definition?

Confused -SWS wrote:Were you referring to "mixed apnea" as:
1) a single event that begins central or obstructive before turning opposite before that same event's completion,
2) a single event that causes a followup opposite-type event (more than one SDB event),
3) an overall condition reflected by some central events and some obstructive events---sometimes even having single mixed events thrown in,
4) some combination of the above three items,
5) none of the above, but something altogether different

I'm trying to figure out what YOU were referring to as "mixed apnea" all along, and I think you were referring to number three above---but could be wrong.

TIA

ozij · Post by **ozij** » Thu Feb 11, 2010 12:42 am

In viewtopic.php?p=449096#p449096

dsm wrote:Now here is another point for learning & debate. In your definition above I understand we can talk of at least 2 ways of identifying Mixed Apnea - the way you already described, plus - an apnea that starts out as obstructive and becomes a central. I am no expert but that is what I understand & will be happy to have this clarified by polite debate should that POV be wrong.

Underline and italics my addition.

In response to -SWS's question:

dsm wrote:Steve,

I already told you, I was referring in particular to this ...

MIXED SLEEP Apnea (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier).
"a condition marked by signs and symptoms of both central sleep apnea and obstructive sleep apnea.
It often begins as central sleep apnea and develops into the obstructive form. Mixed sleep apnea
may also result from obstructive sleep apnea as hypoxia and hypercapnia induce signs and symptoms
of the central form."

Underline and italics my addition.

A clear example of how evolving discussion can change a person's point of view.

O.

dsm · Post by **dsm** » Thu Feb 11, 2010 1:02 am

Ozij

Absolutely

DSM

But tell me, is an apnea a single event situation or can an apnea be a dual event situation ? as in CSA becomes OSA might be described as a dual situation in a single event & an OSA that becomes a CSA might be described as a pair of situations as a related thus 'tied' event ???

On refelection commonsense says an apnea is a single event but I have long ago learned that commonsense means zilch when one gets into a debate with a bunch of very intelligent people and the medical community definitions

D

-SWS · Post by **-SWS** » Thu Feb 11, 2010 2:10 am

dsm wrote:But tell me, is an apnea a single event situation or can an apnea be a dual event situation ? as in CSA becomes OSA might be described as a dual situation in a single event & an OSA that becomes a CSA might be described as a pair of situations as a related thus 'tied' event ???

On refelection commonsense says an apnea is a single event but I have long ago learned that commonsense means zilch when one gets into a debate with a bunch of very intelligent people and the medical community definitions

1) A mixed apnea, a central apnea, and an obstructive apnea each refer to single clinical events (SDB lexicon used both before and after 2005).

2) Mixed apnea as a condition refers to a characteristic distribution of multiple clinical events (SDB lexicon especially favored prior to 2005).

The above seem to fit both common sense and medical definitions. Regardless, I still don't have a clue, dsm, if you have been talking all along about one or both of the above since the Dr. Ahsan correction. At first I thought you were talking about one above. Then with your latest posted definition it sounds as if you were actually talking about two above instead...

Now I'm starting to wonder if you had actually been going back and forth between one above and two above---thinking they were merged into a single category. Not to be confrontational. Rather, I'm just REALLY confused. Sorry about that!

ozij wrote:The only way of arriving at a technical truth is by discussing it over and over, until the facts are clear.

Alright already... I agree!

ozij · Post by **ozij** » Thu Feb 11, 2010 2:43 am

[quote="-SWS"]

Now I'm starting to wonder if you had actually been going back and forth between one above and two above---thinking they were merged into a single category. Not to be confrontational. Rather, I'm just REALLY confused. Sorry about that!

Well, that's OK, -SWS, as long as you're not confused about what the professional's say. After all, our aim is to understand the terms as used by the professionals.

O.

dsm · Post by **dsm** » Thu Feb 11, 2010 2:44 am

SWS

Not to be confrontaional - I stopped replying because no matter what I said you would re-interpret it and feed it back as something I had said that to me I hadn't !!! - more it seems to suit your agenda. This I have come to now realise is the pattern. In fact I will say it has underpinned so many interactions in the past. But, hopefully I am slowly learning (yes I am a bit slow in this regard).

There are so many times in the past I would say something only to have you manipulate it to some meaning I had never even though of and as if I had said it the way you reinterpreted it - often my humour was turned into some sort of personal attack on you then RestedGal would butt in with some outrageous attack on me as being 'a techo wannabe' - 'muddle-headed' - 'delivering a mish-mash' etc: etc: etc:
I find that trying to discuss some things with you as like being in a tag wrestling match in a mud bath with you & RestedGal taking it in turns to do me over sheesh it is such a challenge & here we are where it has happened yet again. RestedGal buts in - delivers her customry insult - then you show up - or you reinterpret something I say as negative & RestedGal turns up & delivers her insult. Lord spare me from tag-wrestling with you two. Especially when it is in a bath of mud (unclear & hard to see the object)

I repeat the following ...

MIXED SLEEP Apnea (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier).
"a condition marked by signs and symptoms of both central sleep apnea and obstructive sleep apnea.
It often begins as central sleep apnea and develops into the obstructive form. Mixed sleep apnea
may also result from obstructive sleep apnea as hypoxia and hypercapnia induce signs and symptoms
of the central form."

Now if this statement is incorrect we should contact the publisher & tell them to either
- remove it
- qualify it, or
- rewrite it

I am happy to follow through once we agree what it should be !

DSM

Muffy · Post by **Muffy** » Thu Feb 11, 2010 2:55 am

dsm wrote:SWS

Not to be confrontaional - I stopped replying because no matter what I said you would re-interpret it and feed it back as something I had said that to me I hadn't !!! - more it seems to suit your agenda. This I have come to now realise is the pattern. In fact I will say it has underpinned so many interactions in the past. But, hopefully I am slowly learning (yes I am a bit slow in this regard).

There are so many times in the past I would say something only to have you manipulate it to some meaning I had never even though of and as if I had said it the way you reinterpreted it - often my humour was turned into some sort of peronal attack on you then RestedGal would butt in with some outrageous attack on me as being 'a techo wannabe' - 'muddle-headed' - 'delivering a mish-mash' etc: etc: etc:
I find that trying to discuss some things with you as like being in a tag wrestling match in a mud bath with you & RestedGal taking it in turns to do me over sheesh it is such a challenge & here we are where it has happened yet again. RestedGal buts in - delivers her customery insult - then you show up - or you reinterpret something I say as negative & RestedGal turns up & delivers her insult. Lord spare me from tag-wrestling with you two. Especially when it is in a bath of mud (unclear & hard to see the object)

I repeat the following ...

MIXED SLEEP Apnea (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier).
"a condition marked by signs and symptoms of both central sleep apnea and obstructive sleep apnea.
It often begins as central sleep apnea and develops into the obstructive form. Mixed sleep apnea
may also result from obstructive sleep apnea as hypoxia and hypercapnia induce signs and symptoms
of the central form."

Now if this statement is incorrect we should contact the publisher & tell them to either
- remove it
- qualify it, or
- rewrite it

I am happy to follow through once we agree what it should be !

DSM

Muffy · Post by **Muffy** » Thu Feb 11, 2010 2:56 am

3 AM!! You better watch that there, -SWS, or we'll be jackin' this thread into the sleep hygiene bucket!

ozij wrote:The only way of arriving at a technical truth is by discussing it over and over, until the facts are clear.

...and over, and over, and over, and over and...

4 AM!! You better watch that there, Muffy, or we'll be jackin' this thread into the sleep hygiene bucket!

Well, hopefully it's just for today, gotta dig out (lookin' out the window, we really only got brushed, but I have to head down south this AM, and it looks like 2 inches of snow per 10 miles) and do the mandatory run. Neither rain, nor snow, etc. etc. Hopefully, it isn't slippery underneath.

Have a great one!

Muffy

A chart showing OSA effects - Part 1

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Re: A chart showing OSA effects - Part 1