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[Diagnosis] Does this indicate CSA?
#1
Does this indicate CSA?
I had a sleep study in July and the neurologist said I had an average of 6 "events" per hour, and that my oxygen levels were dropping significantly. (I don't know anything more specific than that, that's what the neurologist told me and at the time I didn't know to ask for details.) They had me hooked up to about four thousand wires and a pulse oximeter, but nothing measuring my airways, so I don't think the study would have necessarily been able to tell whether my apneas were OSA or CSA. 

I've been using a ResMed Airsense 10 for Her since mid-August, and the machine usually registers upwards of a dozen AHI per hour. According to OSCAR, this is how it went last night, over a period of about 6 hours:
  • Clear Airway 71 events

  • Hypopnea 3 events

  • Obstructive 7 events
Pressure is set to minimum 8 and max 10, and the highest it went last night was 9.8. OSCAR report is attached here.

If this helps, I'm a woman, 39 years old, petite and slightly overweight, with a small jaw. Also, I had a mild case of COVID-19 last April, which may or may not have anything to do with this, but seems like relevant information. I have a followup sleep study with the CPAP scheduled for later this month, but thought I'd check here in the meantime and see if anyone knows what might be going on!


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#2
RE: Does this indicate CSA?
Welcome to the Apneaboard.
As I said on Reddit

Quote:It's all about the data. The number of events does not matter, it is the number of events/hour.
You have a great machine, the AutoSet for Her, for OSA. Unfortunately, you have primarily central apnea. Post a copy of your OSCAR nightly charts and let's see what the data says. Use F12 to take the screenshots.
Ideally start your own thread on Apneaboard.com/forums and post/attach your OSCAR screenshot. What did your diagnosis say? I'll bet it incorrectly said OSA.
A screenshot is much easier to read and the left sidebar contains very important information so next time if you please (see the organize link in my signature.  but here we go and thanks for the data.

I strongly suspect that you have treatment-emergent central apnea happening.  Why? you have an excess of central apneas above and beyond what you stated, and (very important) your EPR is set at 3.  

How does this happen?  CPAP, any flavor or variety, increases the efficiency of your breathing. It increases your Oxygen uptake and your CO2 discharge or flushing.  It is the latter that is more important right now.  
The primary driver for our breathing is the need to get CO2 out of our system. Low oxygen makes us breathe faster, 'high' CO2 makes us breathe period.  So CO2 flushes out of our system faster with either higher PS or EPR (3 is the highest EPR) and in a lucky few (I know, some luck) it decreases the CO2 to below your apneic threshold resulting in a central apnea.  When you are not breathing during the apneic event your CO2 increases to above the apneic threshold and you resume breathing again.  By lowering your EPR we maintain a higher CO2 level in your blood thus avoiding this cause of central apnea.

I believe that you also have other causes based on your report of what your doctor said, but one step at a time.

I'd like you to reduce EPR from 3 to 1 so please set EPR=1
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: Does this indicate CSA?
Thank you very much! Sorry about the format, I've attached screencaps here in case the extra info changes anything. I'll try changing the EPR to 1 tonight and see what happens.


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#4
RE: Does this indicate CSA?
I agree with bonjour on dropping EPR to 1 and then we can see how the CA respond.
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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#5
RE: Does this indicate CSA?
I dropped the EPR to 1 last night and things improved significantly! Hourly AHI 5.12, instead of over 12. Not quite as low as I'd like (I suspect I could stand to increase the pressure a little more), and I still didn't sleep all that well, but it's a move in the right direction. Screenshots are attached.


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