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AHI over 34 mostly obstructive
#21
RE: AHI over 34 mostly obstructive
    This is a shot from last night. I had the head lowered, and slept mostly on my side, and used my new collar. I tried that while in the hospital, and they came and woke me up because my oxygen saturation was too low, and they told me to raise my head some. But I sure was sleeping well.... As you can tell, Obstructive was nonexistent. I have expanded the Centrals to show what someone early described as possible CSR, and to find out if they still thought that likely. I going to contact a pulmonologist soon; waiting on a local recommendation.  Again, thanks for everyone's help.
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#22
RE: AHI over 34 mostly obstructive
An update on my progress with my apnea. I saw a Pulmanologist yesterday as suggested, and here is what we came up with. I will likely have a split sleep study, because there is too much going on to complete it in one night. The second night would start me on a cpap, but quickly change over to a bipap. It is likely that is what I'll wind up with. We discussed the issues with ASV with someone with a heart function at 35 or below; mine being 20, as well as CHF. He said it seemed to be a consensus that the increased death rates could well be that the ASV treatment worked so well patients were going out and over exerting themselves, causing fatal episodes. I thought that was amazing! I would be in that group, so, good to know! I'll offer more when I get through this current process.
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#23
RE: AHI over 34 mostly obstructive
Saltydawg2, the risk factor for individuals with CHF and low LVEF was the result of a study SERVE-HF, that was poorly designed and monitored to make that conclusion The ADVENT-HF study has been in progress for about 8 years, with 732 participants has failed to replicate the higher death rate with ASV. This study was intended to conclude June 21, 2021 and the results will not be published in final form with peer review for some time yet. Early results were announced in Chest Magazine in 2018, and no evidence has surfaced of a change in the path of that study https://www.mdedge.com/chestphysician/ar...-no-safety This shows that the use of modern ASV and proper titration and monitoring likely results in safe, effective therapy for individuals that suffer CHF and have CSR and central apnea issues. I wish that we had better updates from the study, but you should make your doctor aware of ADVENT-HF.

This summary of SERVE-HF and ADVENT-HF is a good starting place to understand the risks, and how these two studies differ, and therefore are coming to very different results. https://www.atsjournals.org/doi/10.1164/...511-2198ED This study discusses heart failure (HF) with reduced ejection fraction (HFrEF).
"The ADVENT-HF trial includes patients with HFrEF with CSA and employs ASV as its intervention but differs from SERVE-HF in key respects. First, unlike SERVE-HF, it includes non-hypersomnolent patients with OSA. To date, 64% of patients enrolled have OSA. Second, treatment is with a different ASV with lower default end-expiratory and minimum pressure support settings (4 and 0 cm H2O, respectively). This should theoretically reduce the risk of lowering cardiac output and of inducing hyperventilation. Data and Safety Monitoring Board review occurs every 6 months, more frequently than in SERVE-HF. After the SERVE-HF press release, the Data and Safety Monitoring Board has reviewed ADVENT-HF event data twice and recommended that enrollment of both patients with CSA and patients with OSA continue."
It appears that the ADVENT HF trial will conclude that advances in ASV machines and better screening of patient comorbidity may mitigate the findings of the SERVE-HF and result in more patients being accepted for ASV therapy. Without the final publication, we just don't know yet.
Sleeprider
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#24
RE: AHI over 34 mostly obstructive
That's a very interesting bit of information, Sleeprider. Thank you for sharing it. I will not actual see him again for three months, when he uploads data from whatever type of machine he selects. He spent a good 45 minutes with me, answering and asking questions, including some not on "The List". He agreed with my concerns that my
previous sleep study Doc did not address the centrals, seeing that they were actually a little higher than the obstructive. I think it's best to see how it plays out. I felt very comfortable with him being so conversational with me.
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#25
RE: AHI over 34 mostly obstructive
I was initially told they had no slot for a sleep study until mid October.  Told the lady I might not be around by then, and that my cpap had given up the ghost. She found someone who had canceled,  and had a slot for that same night. That was last night. Had the usual unaided time for two hours, confirming I was still qualified for a machine. After that, they masked me up, and away we went. Apparently we did fine, until I woke up at 4AM, like I often do.  Breathing seemed funny, and she said that was the machine adding breaths during my Central Apnea events.  I was unable to get back to sleep in the time remaining, even after stopping the extra breath thingy. She  said she would contact the Doc and see if he wanted to set up another night to complete the study, or what.  While she was initially setting me up for sleep, we talked about bipaps, and she mentioned Aircurve S10 Vpap ST. With 20% heart function, CHF, and tachycardia issues, that was the best for me. Keeping in mind of my appointment in a couple of weeks with a cardiologist specializing in CHF, and meeting with the guys that might put in a  Defibrillator/Pacemaker a week after that! Too much going on right now! Feel like I'm just along for the ride, right now.
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#26
RE: AHI over 34 mostly obstructive
Thinking of you and praying for you my friend. I've been wondering how you have been doing. Hang in there. They will figure all this out and have you set up with everything you need!

We are all here for you! Grouphug3
CA and OA decided to call HYOP and the 3 of them crashed RERA's place, and then the 4 of them decided to call Large Leak to meet in an Unclassified location while Rice95 had the best night of his life.


Bed         best sleep I've ever had...
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#27
RE: AHI over 34 mostly obstructive
saltydawg2, hope things are going well for you. Don't forget to mention the collar to your doctors. It amazes me that doctors and sleep centers ignore that as an option... and will categorize someone as untreatable, when a simple collar will keep the airway form collapsing in some cases and allow you to dial pressures down and solve the problem. From what you posted above, your obstructives pretty much went away with the collar on. This is great. And the ST machine will help with your centrals with that timed backup breath. Make sure you tell your Dr about the collar and that they adjust your pressure settings accordingly to minimize centrals in the first place... I have seen Dr's crank up the pressures and create centrals, when a collar and lower pressure solve the problem (family member). If you get a device like the O2Ring, you will find that once you have things dialed in, your O2 should not have drops below 90. Eliminating the apneas and O2 drops, I have been told, takes a lot of the stress off your respiratory and cardio vascular system.
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#28
RE: AHI over 34 mostly obstructive
I had one night of sleep study, and I will have another one within a couple of weeks, adding a continuous oxygen concentrator. The Pulmanologist said the ST, providing the extra "puff" didn't seem to improve my situation, which apparently I didn't tolerate well, anyway. The additional oxygen is to keep my CO2 levels up when sleeping.Guess my next study will tell me everything else needed for a bipap. Oh, and he had previously asked me if I had tried a collar, and I told him, yes. Told him I also had tried taping my mouth, which do not particularly impress him.
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#29
RE: AHI over 34 mostly obstructive
The ST machine is not the correct answer. You should tell them your choice instead of what appears earlier as you letting them pick the machine for you. You'll need to assert you want ResMed AirCurve 10 ASV, not any other less, or far less, effective machine.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#30
RE: AHI over 34 mostly obstructive
I will have an ICD implanted on the 31st. Next sleep study will be 3 weeks later. Now I am to be concerned about magnets in masks that can interfere with ICD functions. I started another thread on that issue. Always something, huh? I did cut the magnets off on of my masks and pop riveted it back together.!
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