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Central apnea events not associated with O2 drop?
#1
Central apnea events not associated with O2 drop?
So, I'm in the Dr office for my 2nd consultation (after having a sleep study, CPAP trial and titration study) - and after reading this board a bit, I have some better questions for him. One question had to do with my concern about still having periods of sleep with very elevated CA events - 60,80, even 90 rates for 30 to 60 minutes. I asked if this still represented a health concern due to lower oxygen for a reasonable period - even if my overall nightly AHI average was around 13.

His advice rather confused & surprised me: The Dr said that he would not worry about Centrals much at all, only Obstructive. As long as CA events average around 10 for the night and OA was close to zero, all was well. He said that a CPAP machine constantly delivers oxygen to you, as long as your airway is open - and it doesn't matter if you inhale - your oxygen level will stay up.

This didn't sound right to me, but I don't have a oxygen monitor or any other online data yet. Physically, it would make more sense to me that you have to breath in order to get oxygen all the way down to where it can be absorbed, and CO2 expelled. I guess there is a bit of pressure for the O2 to diffuse (Graham's gas law), but the lungs are long fine channels, and how long would it take....It was only a 15 min check-in, and I wasn't prepared to question his knowledge.

Anyone hear the same advice / logic? Are CA events safe to ignore at 10 per hour average, including higher clusters of them?

Thanks!
S
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#2
RE: Central apnea events not associated with O2 drop?
my sense is I'm in the minority here but to me, a pause in breathing is a pause in breathing, whether obstructive or central. imo, the only reason to ignore ca is if you know you were awake.
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#3
RE: Central apnea events not associated with O2 drop?
(11-12-2019, 06:04 PM)Schlafer Wrote: I asked if this still represented a health concern due to lower oxygen for a reasonable period.  

I think your concerns are justified and given that is your health well founded. 

OSCAR reports can give you a non-conclusive hint.  If your Minute Ventilation does not drop during the CAs or any other event then that event might not have caused any O2 desaturation.  

The only way to know for sure is to wear a Pulse-Ox all night that records the data.  
 

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Central apnea events not associated with O2 drop?
[attachment=16958 Wrote:WillSleep pid='319061' dateline='1573600235']    
(11-12-2019, 06:04 PM)Schlafer Wrote: I asked if this still represented a health concern due to lower oxygen for a reasonable period.  

I think your concerns are justified and given that is your health well founded. 

OSCAR reports can give you a non-conclusive hint.  If your Minute Ventilation does not drop during the CAs or any other event then that event might not have caused any O2 desaturation.  

The only way to know for sure is to wear a Pulse-Ox all night that records the data.  
 

WillSleep

Thanks WillSleep - I need to learn how to read the "Minute Ventilation" graph - currently it means nothing to me, it just goes crazy during a CA cluster. I have attached a more extreme example. Is it considered "dropped" if any part of the chart dips?


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#5
RE: Central apnea events not associated with O2 drop?
My original pulmonary doc was far more concerned with my 24 obstructive apnea than the 124 central during my last sleep study. Funny, his diagnosis and actions didn't help me get better.

Ignoring aspects like CA events is ignorant on the duck docs part. And unless we've got gills, I'd think actually breathing air in and out is a reasonable expectation for one that desired to stay alive.

No I'm not up to ignoring CA events. OSCAR charts show quite a few CA.

How long have you been on CPAP and especially this machine? That CA count can't be ignored IMO.

BTW do you recall the sleep study event numbers? Better yet can you or have you already posted a redacted detailed sleep study images?
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#6
RE: Central apnea events not associated with O2 drop?
Welcome to the forum, let's see if we can gain some control of this first.
Do you have a history of Centrals, a copy of your diagnostic sleep study, including the charts and tables (did you have centrals pre cpap).  Also your titration study too.

Please set EPR = 1 We may choose to go to 0 tomorrow.  just this one change for now.  Let's see what this does.  A significant drop in CAI would indicate Treatment-Emergent Central Apnea and that we can work on.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Central apnea events not associated with O2 drop?
I do have another thread about my personal "case", and will post my sleep study there now that I have it, along with more current stats. 

This thread was more a general question about...well...if I can trust the Dr. on this aspect. In the end, no surprise if people say "always good to educate yourself" - but wondered if others had heard this same assumption (that CPAP can keep your O2 up, even if you don't inhale).

This sample screen-shot pushing AHI 100/hr was from around week 3 on CPAP. I have lots more just like it from around that time. At about 10 weeks in, my average AHI is currently closer to 6 or 7, but still with significant persistent CA clusters in the 20-40/hr range - hence the O2 concern shared with the Dr. Honestly I was hoping that he would already see that CPAP hardware was not going to be sufficient to get my AHI under 5.0, but he surprised me by saying that CA events up to 10.0 are fine (they don't count).

Thanks!
S
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#8
RE: Central apnea events not associated with O2 drop?
Copy on the other thread and sleep study. I'll go look there.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#9
RE: Central apnea events not associated with O2 drop?
Whatever the type of apnea, we strive for an AHI of 2 - 2.5 not being fussy about deviation from these values. Centrals are the hardest to handle. Point me to your other thread please. 20-40 is way too high.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Central apnea events not associated with O2 drop?
(11-12-2019, 06:27 PM)Schlafer Wrote: Thanks WillSleep - I need to learn how to read the "Minute Ventilation" graph - currently it means nothing to me, it just goes crazy during a CA cluster. I have attached a more extreme example. Is it considered "dropped" if any part of the chart dips?
 
 
"Is it considered "dropped" if any part of the chart dips?" 

No.  Only if your Minute Vent STAYS down below your Median for some period of time.  

In that Screenshot that was showing an AHI of 71 of CAs for that crazy hour 5-6 am your Tidal Volumes and Minute vent were at high levels.  You saw zero desaturation during that time.  

I fully agree with the adjustments and next steps Bonjour posted. 

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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