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[Diagnosis] All central -- should I be concerned?
#1
All central -- should I be concerned?
Hi! I have been a CPAP user for years and recently had a sleep test as my machine had been showing an upward trend in events per hour and that almost all were Central AI. The report shows AHI of 2.4 at 9 cm pressure "with central and obstructive events", although all the events are "Ap C" on the report). In the subsequent doctor discussion, she mentioned that the technician had noted mask leaks and mouth breathing. I was prescribed a chin strap (that I have been using for the last week) and, if that is not sufficient, she will switch me to a full mask. When I asked about the central events I was told we need to control the leaks first and then possibly adjust pressure and that should resolve the central events.

I downloaded my info to OSCAR and see that my results were an average AHI of 10.07 over that last month, ranging from a high of 20 to low of 3.67. Even on nights with no large leaks I note that the events are almost all central (Clear airway). My question is whether you think their plan is going to resolve the issue or should I be pushing for something different (ASV machine?)      

I have attached the sleep test report, OSCAR Overview for about the last month and the results from a recent night.   

Thanks for any insight you can provide!

Sorry, trying the attachments again...


.pdf   Sleep Study 10-20-20 email (002)_Redacted.pdf (Size: 242.23 KB / Downloads: 10)        
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#2
RE: All central -- should I be concerned?
I myself did not see the event breakdown of event count and type. If it were mostly CA you're getting, then the ASV is really the only machine capable of treating. There's 3 variants of CA, treatment emergent meaning the PAP causes CA and the sleep study would not indicate them, pre-existing/predominant means the sleep study did show 50% or more CA then ASV is indicated, idiopathic means unknown medical reason, this too can be where ASV is needed.

I'd suggest writing notes of symptoms and complaints about the sleep events to convey CPAP is not working and you'd need to push hard for ASV. If this is the route taken, request a ResMed AirCurve 10 ASV.
Dave

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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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#3
RE: All central -- should I be concerned?
The study chart shows all central except for an (one) obstructive hypopnea and including 1 central hypopnea. The significance here is they measured central hypopnea, most studies do not.

Because of the fairly low level I'd like to see what your doc wants to do.

For the centrals all we can do is to lower your EPR to 0 from 1.

Suggest to your doc that you expect to lose your insurance due to Covid and you would like to move this as fast as possible, actually faster to the point of getting an ASV bought and paid for prior to the new year.
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#4
RE: All central -- should I be concerned?
i switched from apap to bpap, the new sleep study showed a bunch of hypopneas but when i look at oscar i'm seeing a bunch of ca's and not so many hypo's. my pulmo is highly educated and knowledgeable. he told me that his sleep study equipment is much more sophisticated than the air curve and that the ca's that i'm seeing are probably borderline hypo's that resmed was calling ca's. he also said as long as ahi is below 5 it should be fine. just a comment at this point. no questions yet.
First Diagnosed July 1990

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#5
RE: All central -- should I be concerned?
Your response to pressure support in bilevel therapy is a bit more complicated, and your pulmonologist is certainly aware of this. As you increase pressure support, you enhance ventilation and this is expected to overcome inspiratory flow limitation and hypopnea in most individuals. However, in a number of sensitive individuals, the ventilation results in hypocapnea, resulting from a reduction of PCO3 in the blood (washout of CO2) and a reduction in respiratory drive. This is the "apneic threshold", and you have reached it. As ventilation increased, your CO2 levels dropped, and respiratory drive diminished resulting in lack of respiratory effort, otherwise known as a central apnea. Your airway is not obstructed, you just have no need to take a breath until CO2 builds to a level where autonomic breathing resumes. Unless your "pulmo" is measuring the same condition your machine is measuring, he should not assume you're a loon or the machine is wrong. The detection of respiratory flow is pretty damn good in these machines, and when it flat-lines at zero, it's a damn good indicator of an apnea.
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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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