CAs and Cheyne Stokes?

Hi all, I'm a newly minted hosehead- just completed my 6th night on Auto mode; using Swift FX nasal pillows. I'm supposed to go back to the DME in another week at which time they'll set the machine to constant mode. I was diagnosed with moderate OSA after an at-home recording session, which reported AHI 15.4 and O2 nadir of 84%.
I'm looking at the waveforms every morning before work, and wondering why so many CAs are being reported- for example this annotation from last night; and a close up of the cluster from right before 7 am. Last nights stats:
AHI 12.33
RDI 12.79
OA 0.23 (2 events)
CA 3.95 (34 events)
H 8.14 (70 events)
RE 0.47 (4 events)




I've been reading about Cheyne Stokes and thinking that some of these patterns look a lot like that- but when looking at the pressure readings, I note that the clusters often begin after the machine has ramped up to 10 cm or so... so, can the higher pressure actually induce CAs? Should I be more worried and see the DME or the sleep doc earlier? (Dr followup is scheduled for 2 months out). I have to say, the first two nights weren't bad but the last several have been awful, with mouth popping open several times and waking every hour or so (in part due to a continuous flow of thunderstorms!)
cheers- Scott

Scott

My understanding of Cheynes-Stokes is that it is readily identified by waxing and waning of breathing where the waning part of the cycle results in a CA. But the defining characteristic is the repetitive nature of the cycles and that they usually occur in under 3 mins per cycle.

Periodic Breathing is a variation on the above but as best I understand, and in particular, without the sub 3 minute cycles aspect. Your charts show quite a few minutes per cycle & yes those CAs & Hypops do look bothersome (CompSA ?).

Your charts sure look interesting & I can see why you raised the issue of it being CSR.

Cheers DSM

(the above chart I would take back to my sleep doc - either he will suggest some solution (based on his knowledge of your health & any medication) or may even consider that this may not the right machine for you )

My info relates to Resmed products and you use Rrespironics.
As a result, we can't even communicate.
Sorry.

avi123 wrote:dsm, as I understand it, a Cheyne Stokes Respiration (CSR) wave form shows up AFTER a Central Apnea. The above graph should be spread out to show individual cycles in ordrer to detect CSRs or Periodic Breathings.

<snip>

Cheyne Stokes: This polysomnogram represents Cheyne Stokes breathing and occurred subsequent to continuous positive airway pressure titration for OSA in the same patient in the previous media file. Cheyne Stokes breathing has a classic crescendo-decrescendo breathing pattern

ahi123,
interesting chart & shows the pattern clearly (I just couldn't quite make out the timeline - but it looks like the sub 3 min cycles that define CSR).

Re appearing AFTER a CA am not sure what you mean ?. To have a CA implies a declining breathing pattern to get to the CA ? (so before ? the CA). can you rephrase this as I am not clear on the point - the topic is an interesting one. Classic example of loop gain out of sync.

Cheers

DSM

#2 at a guess, look at a definition of Cheynes-Stokes Respiration as this may help clarify the *after* comment - cheers D

see my posts below

avi123 wrote:DSM check pg 5 here at how I tried to find out a CSR wave formation by the S9 Elite Flow graph:
viewtopic.php?f=1&t=66232&p=620059#p620059
About my above PSG graphs I took it from here:
http://emedicine.medscape.com/article/304967-overview
About the time duration of CSR cycles check this:
I need to locate the report

Not that we should trust everything Wikepedia says, but the entry suggest apnea after the crescendo-decrescendo. I'll look in my traces to see if the periodic wave form started after an apnea; also, wiki says a 30 sec to 2 min cycle (with a reference!)
http://en.wikipedia.org/wiki/Cheyne-Stokes

dsm wrote:Scott
...
Your charts sure look interesting & I can see why you raised the issue of it being CSR.
Cheers DSM
(the above chart I would take back to my sleep doc - either he will suggest some solution (based on his knowledge of your health & any medication) or may even consider that this may not the right machine for you )

thanks DSM, I will definitely point this out next week!
cheers- Scott

avi123 wrote:DSM check pg 5 here at how I tried to find out a CSR wave formation by the S9 Elite Flow graph:

viewtopic.php?f=1&t=66232&p=620059#p620059

About my above PSG graphs I took it from here:

http://emedicine.medscape.com/article/304967-overview

About the time duration of CSR cycles check this:

I need to locate the report

avi123

Am still uncertain what aspect you are highlighting ? - are you talking about a pattern of respiration (i.e. Cheynes-Stokes Respiration) or the individual waveforms captured after one central apnea ?.

CSR is a pattern of respiration. It normally doesn't fluctuate between CS & something else ?. The cause of Cheynes-Stokes is an alternating undershoot / overshoot of the respiratory feedback system (loop gain) that signals the person to accelerate their breathing then to slow it down to the point of stopping - all in an under 3 min cycle (typically closer to 2 mins), but because of a feedback delay the breathe faster/slower signals arrive at the respiratory musculature out of phase with the gas exchange levels (O2 & CO2) taking place in the lungs (alveoli) & as subsequently detected by the respiratory chemo-receptors that in turn signal the body's breathing level..

DSM

#2 changed word or to of (misleading)

see my posts below

avi123 wrote:sorry to intervene

avi123

Sorry that you saw your post as intervening ? - to me all questions asked with serious intent are fair & all opinions put forward with open intent are fair. Sometimes it takes a while to set the same context (be on the same wavelength).

You really didn't need to delete your posts at all as they were very informative & people here like anything that illustrates SDB even if it can be a bit mysterious. Talking thru the details simply & carefully is what really helps us all.

Cheers

DSM

avi123 wrote:sorry to intervene

avi123

Here is an example of where your posts have linked to very interesting & relevant information.

>>
Second Edition (ICSD-2)[2] describes several different entities grouped under central sleep apnea with varying signs, symptoms, and clinical and polysomnographic features. Those that affect adults include primary central sleep apnea, Cheyne-Stokes breathing-central sleep apnea (CSB-CSA) pattern, high-altitude periodic breathing, central sleep apnea due to medical conditions not Cheyne-Stokes, and central sleep apnea due to drug or substance. The primary sleep apnea of infancy primarily affects premature newborns and is excluded from this discussion.
<<

Please don't be so sensitive to what others say or ask of you here. You are by no means stupid, you really do ask/post interesting & relevant info (ignore the bullies who might try to belittle you (I have seen that happen) - many of us know who they are. This forum is just that 'a forum' (though at times you could believe it is a hard nosed school playground where particular dominants 'beat the crap' (metaphorically) out of the innocent/ordinary, who stray from their playground rules) (yes).

I myself learn from the questions & issues you raise & I value your contribution for that reason. All honest folk here want to learn.

Please restore your posts.

Thanks

DSM

Thanks DSM. Please check where I stand now with reference to identifying Periodic Breathing from the Flow graphs obtained by ResScan from Resmed S9 Autoset and S9 Elite. The two machines are using similar technology.

See it on page 5 here:

viewtopic/t66572/viewtopic.php?f=1&t=66 ... 59#p620059

The idea is to scan the Flow graph over time (horizontally) and check for repeats of the comlpexes that are unique to PB and CSR.

This is my source of info regarding the CSR lengths of the cycles:


Central Sleep Apnea and Cheyne-Stokes Respiration

Dai Yumino1,2 and T. Douglas Bradley1,2,3

http://pats.atsjournals.org/cgi/reprint/5/2/226

Read the info about CSR on pg 228

I am not familiar with Respironics machines. So I rather stay away from rendering comments on their graphs.

Regards.

Avi

Thanks for the reference, avi! I'm still mystified about what criteria the Respironics uses to score the various events, but I would think visual examination of the flow charts from both machines would be pretty similar. Although now that I think about it, since I'm running on an A-flex setting of 2, I wonder what corrections the machine has made to the flow data before storing it on the SD card. Still, the periodicity and relative amplitudes are what tell the story, right?

I too value your comments, thanks for helping me to understand this all!
cheers- Scott

p.s. I'm beginning to wonder if this breathing pattern is also happening during the day- my wife accuses me of frequent sighing, and although yes I am depressed a lot, I think its more because I've been breathing shallowly and need a bigger dose of oxygen! I've gotten a recording oximeter so perhaps I should try wearing it during the day (this weekend, not at work!)

Scott,

Questions:

your results in the table show no CSR markings so why would you question it?

can you spread the graph timewise to show single cycles correlated with CAs?



As to your stats, I don't see anything out of the ordinary except a small tilt to CSAS:

AHI 12.33
RDI 12.79
OA 0.23 (2 events)
CA 3.95 (34 events)
H 8.14 (70 events)
RE 0.47 (4 events)

As to the HI at 8.14, if it occured in a Resmed's Autoset then we were told by the Resmed's chief designer of their Autosets to disregard all hypopneas indicated by the machines.

As to your question: I'm beginning to wonder if this breathing pattern is also happening during the day

According to the report by Dr. Bradley, (see link above) CSR and PB respiration patterns also shows up while awake.

milw wrote:with mouth popping open several times

Scott, if there have been times you've been aware of air being pushed out your mouth while wear a nasal (in your case, nasal pillows) mask, it's possible that mouth breathing and/or mouth air leaks are happening quite a bit more while you sleep. If that's the case, therapy air going out into the bedroom instead of straight down where it's needed to keep the airway open, could be a problem.

How has your leak rate been looking?