A chart showing OSA effects - Part 1

Rebecca R wrote:Please don't grin at me like that again Muffy. It frightens me.

Did Rebecca's avatar say that?!

ozij wrote:Rebbeca, the break I wanted was from Dr. Gay of course, not you. I'm just saying this in case it wasn't clear....
O.

It was clear Ozij, but thanks.

rested gal wrote:

Rebecca R wrote:Please don't grin at me like that again Muffy. It frightens me.

Did Rebecca's avatar say that?!

Yep...even with my avatar...I could just feel Muffy turning and lining me up in his sights...

r

Rebecca R wrote:...I could just feel Muffy turning and lining me up in his sights...

Her sights.

Anyway, Muffy don't spend a lot of time "lining things up", as it were:



At 6000 rounds a minute, you don't have to be all that good a shot.

Muffy

Muffy wrote:

Rebecca R wrote:...I could just feel Muffy turning and lining me up in his sights...

Her sights.

Sorry. I just can't keep track of things. Don't aim! I am too tired to run in zig zags.

Anyway, Muffy don't spend a lot of time "lining things up", as it were:



At 6000 rounds a minute, you don't have to be all that good a shot.

Muffy

Especially when the target is a sitting duck in the first place.

This forum is like no other....

r

Rebecca R wrote:

dsm wrote:
I keep asking myself what is 'a mixture of both OSA and CSA' or 'a mixture of OSA' as taken from the presentation and in relation to an OSA event that converts CSA - I just can't see a clear explanation.

CompSA is defined repeatedly as OSA that converts to CSA (see the chart you posted). Where does 'mixture' come into it ?. The OSA doesn't mix or come as a mixture (Mixed Apnea does depending on how you want to define mixture) ?. CompSA 'includes' OSA (that converts to CSA) and CSA but where is the 'mix' / 'mixture' ?. It seems to me it is a stretch of the use of English to say it mixes ?.

Cheers

DSM

#2 - PS I looked at the original Mayo Clinic definition & they don't use the word mixture anywhere
http://www.mayoclinic.org/news2006-rst/3608.html
Extract "The newly discovered type, complex sleep apnea, is a combination of both obstructive and central sleep apneas. " - no mention of mix or mixture.

That was an interesting presentation, but why are you so concerned with the word "mixture" DSM?

Can I hypothesize as to where the word "MIXTURE" came from? Dr. Ahsan indicates by his footnote that he is presenting information originally from Morganthaler et. al. In my experience, when writing papers, preparing presentations etc, it is of the utmost importance not to plagiarize other people's work, so we have to summarize and keep to the closest meaning without using the original author's exact words. There are only so many synonyms for the word combine, but I would guess one of the most common is mix. Could he be summarizing?

My next guess would be that Morganthaler et. al actually used the word mix or mixture. Guess what Morganthaler et. al. Hypothesized on page 1203 of SLEEP, Vol. 29, No. 9, 2006? (I added the bold) :

We hypothesized that, since the differentiating respiratory
feature in CompSAS was the development of central apneas or
Cheyne Stokes pattern mixed in with or superseding the obstructive
pattern, the clinical and polysomnography (PSG) patterns
seen in patients with this disorder should more nearly match those
in patients with the CSA pattern or Cheyne-Stokes breathing syndrome
(which for simplicity we together call central sleep apnea,
or CSA) than those with the OSAHS. We undertook to determine
the prevalence of the CompSAS in a sleep disorders center. Next,
we sought to determine the clinical and PSG features of patients
with CompSAS and compare or contrast them with those of patients
with OSAHS and CSA.

Muffy wrote:And BTW, before you ask:

http://www.ncbi.nlm.nih.gov/pubmed/1885 ... &linkpos=1

Muffy

Not to be a troublemaker Muffy, but there are two articles in that journal printed right next to each other in the Pro/Con Debate section. The other one is called Complex Sleep Apnea: It Really Is a Disease by Peter C. Gay, M.D.page 403-405. Journal of Clinical Sleep Medicine, Vol. 4, No. 5, 2008. I don't think they've decided if it is or isn't yet.

I would also like to see part two of Dr Ashan's presentation.

r

Rebecca,
This current 'discussion' began when I commented that I believed the good Dr Ashan had got Mixed SA & CompSA back to front on his 1st text slide. I said that after reading his description of CompSA. I had never seen 'mixed' & 'mixture' used in regard to CompSA before.

It isn't a big deal & in a later reply to Ozij I commented that rather than say he got them back to front, I really should have said I consider he created confusion by choosing to use the words mixed & mixture in relation to CompSA.

If *anyone* is in doubt about just how confused this topic of definitions for SDB variants can get, just go right back and start reading again - I agreed wholeheartedly with SWS when earlier in this thread he commented that the medical profession was having trouble with definitions of aspects of SDB & I took that to mean that we non professionals would be hard pressed to improve on that

If I were rewriting Dr Ashan's slides today I would still remove the words mixed & mixture from his refs to CompSA - This is my opinion & I respect that others can & do have other opinions on that matter. A case of agree to disagree. I had never expected it to turn into a gun fight

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

DSM

More on the Mixed Sleep Apne point later

On the matter of this topic ...

dsm wrote:

rested gal wrote: <snip>
As I understand it (I could be wrong)...

A Mixed Apnea is a single event that has both central and obstructive components within that one apneic episode. It's a single apnea that starts out as a central (no ventilatory effort) but becomes obstructive when an unsuccessful effort to breathe begins. Mixed apneas can show up in the diagnostic part of a PSG sleep study. Mixed apneas do not mean a person has Complex Sleep Apnea.
<snip>

RestedGal,

As you well know this whole topic of SDB is both vast and complex and that is one reason why educated debate on these topics is a wonderful way for us all to learn & explore. The medical profession has trouble enough let alone us mere mortals who are subject to SDB therapy.

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.

Again, by debating any of these issues openly & politely, we learn, and that is what I am many others come here to do.

Cheers

DSM

Ozij responded to my post thus ...

ozij wrote:

dsm wrote:

rested gal wrote: <snip>As I understand it (I could be wrong)...

A Mixed Apnea is a single event that has both central and obstructive components within that one apneic episode. It's a single apnea that starts out as a central (no ventilatory effort) but becomes obstructive when an unsuccessful effort to breathe begins. Mixed apneas can show up in the diagnostic part of a PSG sleep study. Mixed apneas do not mean a person has Complex Sleep Apnea.
<snip>

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.

DSM, I don' see the idea you bolded in anywhere Rested Gal's text. Frankly I'm surprised any apnea that starts out as obstructive can eventually turn into a central one, as you seem to imply.
In the spirit of educated debate, would you mind sharing you sources for that? You will notice that whenever I point to a definition, I add the link, so that everyone can read the same text I do. The sharing of sources is a sine qua non of educated discussions.

I would also like to add that I will, of course, not debate a definition made by professionals attempting to describe their subject matter. It is the professionals' prerogative to define. It is for us laymen to use the terms carefully, as defined by the professionals.

So, can you please supply links to professional sources in which a mixed apnea is defined as one that starts obstructive, (airway closed, tremendous breathing effort) and then suddenly breathing efforts stop, the obstruction disappears, and yet breathing is not resumed?

TIA for the links.

O.

RestedGal responded with this 2005 reference ...

rested gal wrote:

LINK to the article in Sleep

Link to the task force report on the American Academy of Sleep Medicine site

I responded thus (trimmed down to the 2 salient points that matter - being what I said & what Mosby's medical dictionary said ) ...

dsm wrote:Mixed Apnea
===========
I agree that it doesn't seem to make sense that an obstruction can become a central
& Ozij in a post above has framed questions about how this can occur. RestedGal
has posted a reference to a 2005 Update document that only describes centrals
becoming obstructions. But, there are later publications that explain how
obstructions can become centrals. 2005 is a long time ago in SDB history

Below is the info I have that explains how Mixed Apneas can consist of two variants
Type 1 is the normal & better understood mixed apnea being central=>obstruction, and
type 2 is the less well understood mixed apnea which is when obstruction=>central.

The way I understand an obstruction can become a central is when hypoxia
and hypocapnia triggered by the obstructive phase induce signs & symptoms of a
central apnea as the 2nd phase.
Hypoxia is the lowering of oxygen level. The hypocapnia results from a paCO2 imbalance
(blood CO2 becomes too low) which in turn impacts the respiratory drive. The hypocapnia
signals the sleeper to not breathe while their paCO2 level builds up. One way the
paCO2 level can drop is when the sleeper gasps & hyperventilates momentarily after
the obstructive event & the resulting hypocapnia triggers the central phase.

Below I have highlighted several papers that I understand support this.

DSM

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

<snip>

................

http://medical-dictionary.thefreedictio ... leep+apnea

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.

................

SWS then responded and rightly pointed out the case 1 in my reply referred to a conventional Mixed Apnea, case 2 supported
my position but SWS argued it was a dated view (published 1986).

Then SWS dismissed the Mosb'y medical dictionary reference as also being out of date when in fact it was published in 2009 & thus
was the most up-to-date reference on the matter that anyone has put forward & nobody has come up with a 'proof' that it is either wrong or no longer valid. We have had a *ton* of opinion and attempts to discredit it but not a single proof - does it really matter ? - sure does to the crew with the guns & knives ...

-SWS wrote:

dsm wrote: http://medical-dictionary.thefreedictio ... leep+apnea

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 think that non-specialized medical dictionary reflects what doctors were sometimes calling CompSAS/CSDB way back in 1986---namely a condition called "mixed sleep apnea". And, in fact, the wording "a condition marked by signs and symptoms of both central sleep apnea and obstructive sleep apnea" describes a condition---not at all a singular clinical event such as a single mixed apnea.

Interesting links, none the less. Thanks for posting those.

I posted this

dsm wrote:SWS

I had not understood Mixed Apnea *had* to be a single event ? -- Does it ?
But I am merely an amateur delving into a very complex environment

Cheers

DSM

NOTE! - The debate up until now was still reasonably amicable.



Then SWS posted this ...

-SWS wrote:

dsm wrote:SWS

I had not understood Mixed Apnea *had* to be a single event ?
But I am merely an amateur delving into a very complex environment

Cheers

DSM

If that's true, then the confusion over lexicon in this thread seems to mirror pretty much the same ambiguity and confusion in the medical community prior to 2005 according to Gilmartin, et al:
http://www.ncbi.nlm.nih.gov/pubmed/16217173

A recent report has clarified some of the features of more subtle forms of mixed disease. These include periodic short cycles of obstruction, minimal disease in REM sleep, and incomplete responses to positive airway pressure. Qualitative scoring of this type of disease is limited by imprecision of terms such as 'mixed apnea,' and accurate scoring of central hypopneas is impractical in routine clinical practice. The term 'complex' is used to convey the high likelihood that both obstructive and control factors are involved in creating this pattern of disease

Part of the purpose of that seminal 2005 paper was apparently an attempt to minimize ambiguity of terms regarding "mixed disease"----hence that 2005 proposal to use the term "complex" for the overall condition. Prior to 2005 some medical professionals referred to CSDB/CompSAS as "mixed apnea" while medical professionals also referred to single mixed events as "mixed apneas".

Now they tend to refer to single mixed events as "mixed apneas" while referring to SDB with a mixture of both event types as "complex".

NOTE - Seemed to me a friendly way of explaining the situation & one I felt was in the spirit of open discussion So I graciously replied ...

dsm wrote: 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

Why my reply above should trigger a gun/knife fight I am not 100% sure. One conclusion I came to was that
maybe SWS looked at the Mosby's Medical Dictionary entry I was referring to & finally realized it was
published in 2009 & thus to anyone reading the debate made it look like I (dsm) had a very valid point
that now needed to be shot down. SWS lacked the ammunition & the tactic was to push me into providing it.
SWS is one ballsy debater - no quarter given.

Anyway, the hard nosed tactics then began & whilst I believe anyone here can read the Mosby's Medical Dictionary
on Mixed Sleep Apnea & understand exactly what it says, SWS proceeded to claim he didn't understand what I
had said (which was a rephrasing of the Mosby Mixed Sleep Apnea definition ).

So SWS was pushing me to keep restating my POV until I framed it in a way he could shred. So I hardened my
position by sticking to that Mosby's definition alone
& suggested that if it was wrong SWS should say where it was wrong & I would take that to the publisher. That
suggestion from me got ignored (as I was sure it would be). Then as the tone of the debate declined further I
backed right out.


Since backing out I was waiting to see if anyone would address the veracity of the quote from Mosby's. SWS &
Muffy both expressed opinions but nothing to prove it was wrong. To this date no one has discredited it.

BUT, lets suppose one of us DID or DOES find a reason or a proof that Mosby's definition of Mixed Sleep Apnea was
wrong, all that would prove is that we non medical types are at the mercy of a confused industry & to turn
a discussion like this into a gun/knife fight over confused medical terminology that the medical profession
can't get right, is simply disgusting. The brawling mess has done nothing for the people coming here
seeking some clarity & meaning to their SDB problems.

DSM

dsm wrote:


Rebecca,
This current 'discussion' began when I commented that I believed the good Dr Ashan had got Mixed SA & CompSA back to front on his 1st text slide. I said that after reading his description of CompSA. I had never seen 'mixed' & 'mixture' used in regard to CompSA before.

It isn't a big deal & in a later reply to Ozij I commented that rather than say he got them back to front, I really should have said I consider he created confusion by choosing to use the words mixed & mixture in relation to CompSA.

If *anyone* is in doubt about just how confused this topic of definitions for SDB variants can get, just go right back and start reading again - I agreed wholeheartedly with SWS when earlier in this thread he commented that the medical profession was having trouble with definitions of aspects of SDB & I took that to mean that we non professionals would be hard pressed to improve on that

If I were rewriting Dr Ashan's slides today I would still remove the words mixed & mixture from his refs to CompSA - This is my opinion & I respect that others can & do have other opinions on that matter. A case of agree to disagree. I had never expected it to turn into a gun fight

I will not go right back and start reading again. You can’t make me! That would be cruel and unusual punishment.

r

Rebecca R wrote:

dsm wrote:


Rebecca,
This current 'discussion' began when I commented that I believed the good Dr Ashan had got Mixed SA & CompSA back to front on his 1st text slide. I said that after reading his description of CompSA. I had never seen 'mixed' & 'mixture' used in regard to CompSA before.

It isn't a big deal & in a later reply to Ozij I commented that rather than say he got them back to front, I really should have said I consider he created confusion by choosing to use the words mixed & mixture in relation to CompSA.

If *anyone* is in doubt about just how confused this topic of definitions for SDB variants can get, just go right back and start reading again - I agreed wholeheartedly with SWS when earlier in this thread he commented that the medical profession was having trouble with definitions of aspects of SDB & I took that to mean that we non professionals would be hard pressed to improve on that

If I were rewriting Dr Ashan's slides today I would still remove the words mixed & mixture from his refs to CompSA - This is my opinion & I respect that others can & do have other opinions on that matter. A case of agree to disagree. I had never expected it to turn into a gun fight

I will not go right back and start reading again. You can’t make me! That would be cruel and unusual punishment.

r

LOL !

So does that now mean I have a sort of shield to defend myself with

Cheers

DSM

dsm wrote: LOL !

So does that now mean I have a sort of shield to defend myself with

Cheers

DSM

DSM, I say when you find yourself in a gunfight with more and bigger guns than yours, surrender.

r

time to bail...

Rebecca R wrote:

dsm wrote: LOL !

So does that now mean I have a sort of shield to defend myself with

Cheers

DSM

Shield?! I must say I would make a lousy shield, especially to defend yourself with.

DSM, I say when you find yourself in a gunfight with more and bigger guns than yours, surrender.

r

R

It can be tough for some of us, but sometimes one just needs to walk away

DSM

(but of course on the above post you are 'dead' right )

Just for fun, below are ALL the "mixed apnea" definitions rendered on Google Scholar by searching for the quote-enclosed string text "mixed apnea is defined":
http://scholar.google.com/scholar?hl=en ... =&as_vis=0

Gun fights? I love glorifying larger-than-life metaphors to describe highly basic quibbling... Good thinking!

-SWS wrote:Just for fun, below are ALL the "mixed apnea" definitions rendered on Google Scholar by searching for the quote-enclosed string text "mixed apnea is defined":
http://scholar.google.com/scholar?hl=en ... =&as_vis=0

Gun fights? I love glorifying larger-than-life metaphors to describe highly basic quibbling... Good thinking!

You are a treat SWS - a worthy debater

Try this link as well

http://scholar.google.com/scholar?hl=en ... =&as_vis=0

DSM

Got it... thanks for posting those...

Remind me again which of those "proofs" helps us to realize that Dr. Ahsan had his definitions back to front?

P.S. I'm bailing out while everyone's still laughing and smiling. The important thing is that everyone got to think for themselves, and everyone got to walk away with their own opinion.

-SWS wrote:Got it... thanks for posting those...

Remind me again which of those "proofs" helps us to realize that Dr. Ahsan had his definitions back to front?

P.S. I'm bailing out while everyone's still laughing and smiling. The important thing is that everyone got to think for themselves, and everyone got to walk away with their own opinion.

Steve,

You are joking aren't you ? - RE 'back-to-front', didn't you read my much earlier reply to Ozij & today's earlier one to Rebecca ???

DSM

I agree - time to bail out

I will leave this little gem in regard to sources of medical definitions

"Mosby's Medical Dictionary is an incredibly useful tool for those entering into the health professions. For many, learning medical terminology is like learning a foreign language, and a good medical dictionary is necessary. Students may refer to Mosby's as a tool for completing a term paper. Doctors may use Mosby's when submitting an article to a medical or other scientific journal. When using Mosby's as a reference, a proper citation must be included with these literary pieces. American Psychological Association (APA) is the most commonly used method of citation."

But god forbid that any of us use it to do things like this ...

Doctors may use Mosby's when submitting an article to a medical or other scientific journal.

Because according to SWS & RestedGal they may get discredited. How do I know, just ask me

DSM