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AHIs Good, Waveforms? Not So Much
#1
AHIs Good, Waveforms? Not So Much
[attachment=21031][attachment=21032][attachment=21034]Greetings, all.
 
I’m a 70 year old male who has been on APAP for a month now for mild to moderate sleep apnea. In lab polysomnography showed an AHI of 15.5 and an RDI of 31.1. CAHI was only 1.8 on the night of the test, OAHI was 13.8. RERA index was 93.2 supine and 19.6 prone. Scoring comments indicated that a slight Cheyne Stokes breathing pattern was seen while sleeping (Not quantified). SpO2 was below 88% for 23.6 minutes. No PLM arousals seen.

Toward the end of 2019 I was diagnosed with a moderate to severely stenotic aortic valve, and went through a complete workup aiming at a TAVR (Trans-catheter Aortic Valve Replacement). It turned out that they don’t make an appropriately sized valve for that procedure, so now I’m waiting to get off Plavix so I can have a conventional valve replacement, possibly in June or July.

While all this was going on, I bought an O2 Ring recording pulse oximeter. Nightly desaturations were often in the low to mid 70s, with up to 1-1/2 hour’s time at less than 90% occurring quite often. This is what finally lead me to getting a sleep study.

I got a ResMed AirSense 10 Autoset about 1 month ago, and have been self titrating based on what I’ve learned from you folks. AHIs started out in the 10 to 18 range, with a large central component. I’ve also seen Cheyne Stokes reported. I’m now fairly consistently down in the 1 to 2 AHI range.

My problem is, I still have what I think are excessive flow limits and high loop gain breathing patterns (Stokesish??) for significant portions of every night.

My O2 levels have significantly improved, and are rarely below 90% for more than a couple minutes now. I’m sleeping slightly better now, but still wake up several times a night.

I have some Diamox ordered to see if that will help the breathing patterns, but my gut feel is that ASV might be the answer.

Do any of you have suggestions for anything else I can try at this point? I’ll post my last daily with a couple short time clips. Let me know if you need anything else.

Thanks in advance for your help.

Larry


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#2
RE: AHIs Good, Waveforms? Not So Much
I don’t see any need for an ASV based on these graphs. A VAuto with its ability to provide additional pressure support may be useful to help reduce the flow limitations
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#3
RE: AHIs Good, Waveforms? Not So Much
Thanks for the reply, jaswilliams. The screen caps I posted were from one of my best days. The centrals and the really bad oscillations seem to come and go. Or maybe, between CPAP, cardiac rehab and heart meds things are getting better.

I haven't seen many other people's posts including Minute Vent. Mine doesn't seem normal to me.

Here are a couple caps of bad nights.


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#4
RE: AHIs Good, Waveforms? Not So Much
Raised min and max pressures each by 1 cm H2O to see if flow limits would change. No significant difference. More centrals were reported, but I'm beginning to think it's just a matter of at what threshold the algorithm flags events.

Larry


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#5
RE: AHIs Good, Waveforms? Not So Much
your sleep study didn't show plm 'arousals'. did it say anything else about plm? I have a bookended pattern in my flow rate that I know to be plm. since I've been taking meds for it, I've been seeing another pattern just like what I see in your charts - softer, a bit more sinusoidal in shape, repetitive - that I suspect is plm as well. often coinciding with flow limitations, oa, ca & h. I'm no expert so just throwing it out there as something to keep in the back of your mind.
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#6
RE: AHIs Good, Waveforms? Not So Much
The Periodic breathing you show here terminated with either a Hypopnoea or CA in the middle shows the need for an ASV. One thing with CA’s is it’s consistently inconsistent. The first step would be to reduce or turn off EPR this may reduce the periodic breathing but flow limitations will increase but otherwise an ASV is your only option.
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#7
RE: AHIs Good, Waveforms? Not So Much
Hi sheepless,

Thanks for the reply. PLM Arousal index was 0.0, PLM index was 5.2, and the report said "No independent limb movement disorder was identified".

Right now I'm thinking along the lines of what Dr. Robert J. Thomas calls high loop gain breathing. Having an electronics background, I equate it to servo oscillation.

I will keep PLM in mind. Thanks for bringing it up.

Larry
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#8
RE: AHIs Good, Waveforms? Not So Much
Thanks jaswilliams.

I'll turn off EPR tonight and return min and max pressures to 9 and 17. I had tried EDM at 2 instead of 3, but there wasn't a significant change.

I'll post some more tomorrow.

Larry
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#9
RE: AHIs Good, Waveforms? Not So Much
Turning off EPR may not have a positive effect but it costs nothing to try
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#10
RE: AHIs Good, Waveforms? Not So Much
Agreed. It's a dot the Is, cross the Ts move, but we need to know.

Thanks,

Larry
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