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[CPAP] Potential CSR?
#1
Potential CSR?
Hi all,

Recently started APAP therapy (been using for almost a week now) after getting diagnosed with OSA.  Sleep study results were as follows.

Total AHI: 27.9 (192 events)
Hypopnea AHI: 18.6 (128 events)
Central Apnea AHI: 3.5 (24 events)
Obstructive AHI: 5.5 (38 events)
Mixed AHI: 0.3 (2 events)

Currently on a trial of APAP with a pressure range of 4.0-20.0 however pressure is typically around 4-6 mmH2O and doesn't exceed 10 mmH2O.

I've noticed some occasional periods of detected CSR, currently on 2/5 days where I've used the treatment.  Attached is some of the data from OSCAR.
  1. Overview of 15/07/22
  2. Zoomed in on CSR event 15/07/22
  3. Zoomed in on CSR event 20/07/22
Just wondering if anyone has any experience with this or has any recommendations on what to do.

Thanks.

           
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#2
RE: Potential CSR?
Do you have any heart issues?
Any indication of CHF? I'm expecting a no.

Please ask your doctor the above.

What is happening is that you as a individual are very sensitive to your CO2 levels. The need to eliminate or flush out CO2 is what provides our drive to breathe. When our CO2 is "high" we exhale deeply to reduce our CO2 levels, and gradually smaller and smaller breaths as the CO2 level drops until it is below your apneic threshold and you stop breathing. Obviously with not breathing CO2 levels build up and once above the apneic threshold you gradually start breathing deeper and deeper. This repeats as the cyclic pattern you see in your charts.

To be CSR it needs a cause such as CHF which has a strong association with CSR thus, out of an abundance of caution, a suggestion to check with your doctor. Otherwise this is just periodic breathing and other than not liking it it does little to no harm. Over time, several months it should go away if it is not heart related
.
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#3
RE: Potential CSR?
Hi Gideon,

Thanks for your reply.  I did have some issues with my heart when I was a child (around 10-12 years old), they never really identified the exact issue but it was a problem with the left ventricle.  The issue was basically severe chest pain when exercising so I was not allowed to do any physical activity for 2 years at which point the issue seemingly resolved itself.

Since then I don't think I've had any heart issues (I'm 27 now), although occasionally I have chest pains and I have high Diastolic BP typically around 130-135 while Systolic BP is around 70 with no obvious cause (not overweight).

Other symptoms than OSA are:
  • Anxiety
  • High Diastolic BP (isolated diastolic hypertension (IDH))?
  • GERD
I've been assuming that my other symptoms are related to OSA, i.e. Poor sleep causing Anxiety which leads to high BP and potentially GERD which leads to poor sleep etc.  However I haven't noticed much improvement in any of my symptoms since starting APAP and still experience GERD & high BP on days where I'm not feeling anxious at all.  

Your suggestion of me being sensitive to my CO2 levels sounds interesting, during my sleep study my oxygen levels looked pretty decent considering the OSA, could this maybe point in that direction?
  • Average Sp02: 95%
  • Min Sp02: 89%
  • Time < 90%: 0.05%
  • Time < 85%: nil
  • Time < 80%: nil
  • ----------------------
  • Desat < 10 secs: 0
  • Desat > 10 secs - < 20 secs: 13
  • Desat > 20 secs - < 30 secs: 27
  • Desat > 30 secs - < 40 secs: 11
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#4
RE: Potential CSR?
I'd be more interested in seeing your history of Central Apnea. A Full copy of a sleep test including the charts and tables in addition to the narrative.
The CO2 issue with CHF is caused by the heart failure resulting in lower circulation. This results in the same pattern but with a very traceable cause, the CHF, thus the elimination step with your doc. As I said I don't expect you to have CHF.

I expect this is Treatment Emergent Central Apnea or Complex Apnea. two different names for the same thing. How often does this occur, Every Night?
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#5
RE: Potential CSR?
I've attached my sleep study report below.  Looks like I also had periods of CA during the study which appears similar to what I'm experiencing now.  I'm assuming this means I should be looking at getting an ASV machine?

Not every night gets periods of "CSR" detected however all nights have some clusters of CA with sinusoidal breathing patterns.  Sounds like I have complex apnea?

           
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