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Can anybody comment on this desaturation behaviour?
#41
RE: Can anybody comment on this desaturation behaviour?
(01-08-2022, 07:09 AM)pholyny Wrote: That's a bit optimistic, I think. My quadruple bypass took a day - counting prep and waiting time - and then I was in the CICU for four days, recovery floor two more, and finally the rehab hospital for three weeks.
Fair enough. I've been caught out by the blind optimism of surgeons before as well. Even when procedure times are short, I've found that recovery can take a lot longer than I was led to expect.
Still, I believe there is a way to close a PFO without opening the chest these days. At least, I hope there is Wink
Best wishes, DS
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#42
RE: Can anybody comment on this desaturation behaviour?
My point was more that while having a PFO isn't rare, having one that causes symptoms because of the shunting is, and (at least to me) doesn't really count as "OK".

That said, yes - I understand that PFOs can be fixed by putting a catheter into a vein (usually the femoral, if my stepdad's experiences are anything to go by) and pushing it up into the heart, before deploying a patch to close the hole. The procedure itself shouldn't be TOO huge, but obviously, how the procedure goes and if they have to do something more invasive is going to determine how long they have you in hospital and what ward/s. A bypass is definitely a bigger procedure with a longer hospitalisation time as a whole.
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#43
RE: Can anybody comment on this desaturation behaviour?
I've noticed, while looking through my recordings, that I often have long periods (minutes to hours) of periodic breathing like the one I've attached. You can see that sometimes these are marked as apnea/hyopnea events by the ResMed, but just as often they aren't. Sometimes they appear in the context of reported flow limitations, but just as often they don't.

Most of these ventilation minima don't prompt the ResMed to take any action. If it thinks that there's flow limitation involved, the machine usually raises the pressure. In most of the examples I've found, when the (inspiratory) pressure gets up to about 13cm, my breathing normalizes. Of course, that could just be a coincidence: even when I've set the pressure really low (4cm) the periodic breathing always terminates on its own in the end.

Over the weeks I've tried many different settings on the machine, but none seem to make much difference -- I see this behaviour every night, whatever the settings. Every cycle is accompanied by a variation of 2-3 percentage points in my SpO2.

I'm not overly concerned about it, except that there could disturbances in my breathing that are not included in the AHI score. If that's the case, it make it hard to trust the AHI score as an indicator of how well CPAP is working.

Comments welcome.

BW, DS


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#44
RE: Can anybody comment on this desaturation behaviour?
AHI is a specific measure, but it doesn't cover all SDB.

This is why I use the User defined measures as well, and find that OSCAR pretty accurately scores these flow restrictions (i.e. almost apneas/almost hypops) that also disturb my sats without meeting the criteria for a full event. Bbut even so, it's not designed to map and catch every issue.

The periodic pattern looks central, to me. In fact, I wouldn't have been surprised to find that the OA that was tagged was actually central. That said, it could be treatment emergent due to the better ventilation on PAP. Without a sleep study, it's hard to tell if it's a side effect of the therapy or an underlying sleep disorder, or your PFO or arrythmias.
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#45
RE: Can anybody comment on this desaturation behaviour?
(01-11-2022, 09:08 AM)Ratchick Wrote: The periodic pattern looks central, to me. In fact, I wouldn't have been surprised to find that the OA that was tagged was actually central. That said, it could be treatment emergent due to the better ventilation on PAP.

Yeah. This is why I'm increasingly keen to understand how this treatment-emergent behaviour actually arises. I see the periodic breathing behaviour in the very first set of data I managed to record, which was on my third night with CPAP (it took me two nights to realize that there was a memory card slot).

I'm not really concerned about this, except to the extent that it could be waking me up in the same way that a "real" apnea is thought to. It doesn't seem to affect my average oxygen saturation much, but when it's already low, it makes the minimum even lower.

BW, DS
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#46
RE: Can anybody comment on this desaturation behaviour?
Yeah, the issue is determining if it's actually treatment-emergent, or if you actually have some centrally mediated sleep-disordered breathing (whether apnea or no). Which is why you need a sleep study really, preferably with an ECG in paralell.
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#47
RE: Can anybody comment on this desaturation behaviour?
I am kind of leaning central but there are some signs of potential obstruction as well. Hard to know which one is at play (or both).

If central the biggest change should come from dropping EPR to 2 or 1.

If obstructive it could potentially be positional related. Might have been sleeping on the edge of your pillow at that point or something like that. A trial of thinner pillow, cervical collar etc might help. Higher pressure might help too but if this is only occasional probably isn't worth treating that way.
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#48
RE: Can anybody comment on this desaturation behaviour?
(01-11-2022, 12:14 PM)Geer1 Wrote: I am kind of leaning central but there are some signs of potential obstruction as well. Hard to know which one is at play (or both).

If central the biggest change should come from dropping EPR to 2 or 1.

Yeah. It's tricky, because I have some measure of flow limitation reported most of the time. When I see this periodic breathing, I usually see some flow limitation near it, even if not at exactly the same time, because I always have some flow limitation. I see flow limitation even with pressure at 16cm, which is the most I've used.

I did try reducing EPR to 2, but the problem was still there. It might have been a little less prevalent but, because it's so variable anyway, it's hard to know if the change made any difference. We've had this discussion elsewhere, but I remain sceptical about the effect of EPR on treatment-emergent CA. I'm not saying you're wrong, but I've not seen such an approach recommended anywhere except this forum. Of course, I could be looking in the wrong places.

Posture and what-not are certainly things I need to investigate. The sad fact is that there is no sleeping position that feels comfortable or natural to me with a mask on, and I often end up with my head in a weird position.

Best wishes, DS
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#49
RE: Can anybody comment on this desaturation behaviour?
It may not hurt to try reducing EPR to 1 or off and see what happens over several hours if not the entire night. The more time the edit is tried the better we gauge how it may or may not help. That is if CA are at levels worth acting against.

Do note the teeter-totter dilemma, actions on CA by reducing EPR will likely increase Obstructive Apnea, Hypopnea, and FL. Vice versa, if you increase EPR to address Obstructive Apnea, Hypopnea, and FL then CA will very likely increase. Equal and opposing results.
Dave

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#50
RE: Can anybody comment on this desaturation behaviour?
(01-11-2022, 02:26 PM)SarcasticDave94 Wrote: Do note the teeter-totter dilemma, actions on CA by reducing EPR will likely increase Obstructive Apnea, Hypopnea, and FL. Vice versa, if you increase EPR to address Obstructive Apnea, Hypopnea, and FL then CA will very likely increase. Equal and opposing results.

Thanks. I've seen this advice given many times on this forum, but (so far as I can see) nowhere else. Does this come from the combined experience of forum users, or is there some published research that tests these things?

BW, DS
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