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Central sleep apnea periodic breathing
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swwalden1 Offline

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Post: #71
RE: Central sleep apnea periodic breathing
The screenshot I posted in the original post sure looked like Cheyne-Stokes periodic breathing to me. That's why I posted it and asked for other's opinions. When I showed it to my pulmonologist he said no: I think because I am not on narcotics nor do I have congestive heart failure. My Pulmonologist was convinced that this breathing pattern was being caused by my new BiPAP machine, and I am pretty sure he is correct. He assured me I didn't need to make an appointment with a cardiologistSmile

I don't think, in my case, that it makes any difference whether this is Cheyne-Stokes periodic breathing or just looks like Cheyne-Stokes periodic breathing or if it's something else. While CAs still make up the majority of my apnea events, my AHI is now mostly below 5 and below 3 for the last 5-nights. So they are no longer a major concern.

I can't say for sure whether tweaking my machine settings caused the improvement, or if my body just acclimated to the new thearapy. It was probably a combination of both. I made a lot of pressure adjustments zeroing in on reducing my nightly AHI. The change that coincided with the biggest drop in nightly CAs was, as I mentioned in my post above, when I dropped my PS from 4 to 2--which as has been pointed out can increase CO2 in the blood stream thus reducing CAs.

Steve
07-11-2015 02:21 PM
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mollete Offline

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Post: #72
RE: Central sleep apnea periodic breathing
(07-11-2015 02:01 PM)vsheline Wrote:  In CSR, each cycle usually lasts between 30 seconds and 2 minutes...

But I think the doctor may be saying CPAP treatment-caused CSR mimics true CSR, which in his understanding is disease-caused CSR.

OK, you got me a little confused there, but treatment-emergent CompSAS cycles are ~25 seconds, per Thomas and Gilmartin, who invented CompSAS:

'classic paper Wrote:Polysomnographic recognition of complex sleep-disordered breathing in 90-second epochs. Above, polysomnogram showing the typical features of complex disease not associated with classic periodic breathing, Cheyne-Stokes respiration, or central apneas. The cycles of respiratory abnormality are short (~25 seconds) and are obstructive.

BUT:

Quote:Prolonged circulation time remains important for the induction of periodic breathing and central sleep apnea, but it is not the critical factor for the majority of those with complex sleep-disordered breathing. The cycle length is certainly modulated by circulation time (increased when longer).

So "IMHO" those long cycles need review.
(This post was last modified: 07-11-2015 02:22 PM by mollete.)
07-11-2015 02:21 PM
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tedburnsIII Offline

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Post: #73
RE: Central sleep apnea periodic breathing
(07-11-2015 02:01 PM)vsheline Wrote:  In CSR, each cycle usually lasts between 30 seconds and 2 minutes.

From Wikipedia:
https://en.m.wikipedia.org/wiki/Cheyne-stokes_respiration

Cheyne–Stokes respiration /ˈtʃeɪnˈstoʊks/ is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes.[1] It is an oscillation of ventilation between apnea and hyperpnea with a crescendo-diminuendo pattern, and is associated with changing serum partial pressures of oxygen and carbon dioxide.[2]

References
[1] "Cheynes–Stokes Respiration". WebMD LLC. Retrieved 2010-10-05.
[2] "Cheyne–Stokes respiration". WrongDiagnosis.com. Health Grades Inc. Retrieved 2010-09-03


Is it possible to have a CSR-type pattern of breathing where the machines will not report it as some kind of apneaic event (ap, hyp, CA)?

Question posed in part because some machines, including mine, do not have access to SleepyHead.
(This post was last modified: 07-11-2015 03:04 PM by tedburnsIII.)
07-11-2015 02:47 PM
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vsheline Online

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Post: #74
RE: Central sleep apnea periodic breathing
(07-11-2015 02:21 PM)mollete Wrote:  ... but treatment-emergent CompSAS cycles are ~25 seconds, per Thomas and Gilmartin, who invented CompSAS:

'classic paper Wrote:Polysomnographic recognition of complex sleep-disordered breathing in 90-second epochs. Above, polysomnogram showing the typical features of complex disease not associated with classic periodic breathing, Cheyne-Stokes respiration, or central apneas. The cycles of respiratory abnormality are short (~25 seconds) and are obstructive.

Hi mollete

That quote appears in these classic articles:
http://www.journalsleep.org/ViewAbstract.aspx?pid=25945
http://www.medscape.com/viewarticle/515202

The quote is describing one type of obstructive apnea pattern which is not treatment-emergent. It is seen even before PAP treatment, but it is predictive of CompSAS.

Treatment of the obstructive apnea pattern described in the quote may require a PAP machine with a backup respiration rate (such as an ASV machine), because treatment-emergent central apneas tend to appear at pressures lower than would be adequate to prevent these obstructive apneas.

Therefore, although these are obstructive apneas, it appears these are related to central sleep apnea and have a central component, and before pressures get high enough to completely prevent the obstructive component central events like Periodic Breathing or CSR start appearing.

Quote:BUT:

Quote:
Prolonged circulation time remains important for the induction of periodic breathing and central sleep apnea, but it is not the critical factor for the majority of those with complex sleep-disordered breathing. The cycle length is certainly modulated by circulation time (increased when longer).

So "IMHO" those long cycles need review.

Hi swwalden1,

If you haven't seen a cardiologist in the past year or two, I would certainly recommend seeing one, to see how things are going in your cardiovascular system. (I see mine every 6 months, but I have a heart condition or two or three.)

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 07-12-2015 01:30 AM by vsheline.)
07-12-2015 01:01 AM
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mollete Offline

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Post: #75
RE: Central sleep apnea periodic breathing
(07-11-2015 02:47 PM)tedburnsIII Wrote:  Is it possible to have a CSR-type pattern of breathing where the machines will not report it as some kind of apneaic event (ap, hyp, CA)?

Depends on the obvious-ness of the events.
(07-12-2015 01:01 AM)vsheline Wrote:  That quote appears in these classic articles:
Thanks. It would appear that I do not have enough privileges yet.
...or yet...
(This post was last modified: 07-12-2015 06:07 AM by mollete.)
07-12-2015 06:04 AM
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mollete Offline

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Post: #76
RE: Central sleep apnea periodic breathing
...or yet...
(This post was last modified: 07-12-2015 06:10 AM by mollete.)
07-12-2015 06:07 AM
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mollete Offline

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Post: #77
RE: Central sleep apnea periodic breathing
..or yet...
07-12-2015 06:14 AM
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mollete Offline

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Post: #78
RE: Central sleep apnea periodic breathing
(07-11-2015 02:47 PM)tedburnsIII Wrote:  Is it possible to have a CSR-type pattern of breathing where the machines will not report it as some kind of apneaic event (ap, hyp, CA)?
IMHO I think some stuff can sneak by. Look at this from the other thread. This is some fairly significant PB, but the algorithm only called a couple of RERAs (and they sure ain't RERAs):

[Image: pb_zpsuxuyzuqm.jpg]
07-12-2015 08:28 AM
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PaytonA Offline
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Post: #79
RE: Central sleep apnea periodic breathing
I think that you will find that the definition of CSR includes an apnea in the trough. On the other hand patterned breathing has a hypopnea in the same location. So no, I do not think that it is possible to CSR without apneas.
07-12-2015 11:21 AM
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tedburnsIII Offline

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Post: #80
RE: Central sleep apnea periodic breathing
(07-12-2015 11:21 AM)PaytonA Wrote:  I think that you will find that the definition of CSR includes an apnea in the trough. On the other hand patterned breathing has a hypopnea in the same location. So no, I do not think that it is possible to CSR without apneas.

Same location meaning the trough?

So, assume hypothetically that a person has an AHI of <5, and there are some apneas, hypnopneas, and clear airway events reported.

Without the benefit of SleepHead graphs/charts re respiration rates, flow, etc. there would be no way to even suspect CSR?

Assume another hypo where AHI is 0. What can be assumed re possibility of CSR for that night?
(This post was last modified: 07-12-2015 12:31 PM by tedburnsIII.)
07-12-2015 12:27 PM
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