Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

High AHI and Cheyne Stokes respiration, what to do?
#1
High AHI and Cheyne Stokes respiration, what to do?
Hello, I am new here,
My husband of 77 has been using a ResMed Aircurve 10 VAuto for 3 months. He was recently diagnosed with 44 apneas/hour. (after searching for over 3 years why he was so tired, he also has had asthma since childhood, never treated until 5 yrs ago and it is not really an improvement. In this 3 years he also had an extensive heart function check, all was fine. Now with the sleep test it  showed that he is having arythmia, irregular heartbeat, so that is something more recent)
The first month the lung doctor had the CPAP on pressure 6, then next month on 9. 
Due to some absurd mistake in the Belgian law, my husband was denied health insurance because he now finally received his small American pension, after being married and living in Belgium for 25 years, so we had to return the CPAP machine.
So I decided to find a way to download the information and found this forum and Oscar. Thank you all for that.
This way I found out that with the pressure fixed on 9, he had an average of 41 apneas per hour and almost constant Cheyne Stokes. So I changed the setting to automatic first from 4 to 20, later from 4 to 16 and we got a better result, with AHI between 18 and 37. (still really bad, I know)
I did a test with the pressure on 4, showing a lot of Obstructed airway. On the auto setting he has then about the same amount of apneas but many of them Central apnea with open airway.
The big difference with the machine is that he doesn't wake up all plugged up with mucus.
I ordered a BiPAP, because I read that it might help better with central apnea and CSR, it's been delayed due to electronic supply problems, so my husband didn't have a machine for 10 days, he got worse every day, woke up in the morning more plugged up than ever, couldn't hold his pee during the night. So I ordered a ResMed Aircurve 10 VAuto, which was available right away, since then he's a bit better again.
I will add 2 screenshots from Oscar, one on the settings we are using now, and one on pressure 4 all night as a reference. 
I hope someone wants to have a look and maybe give us some advice.
Since we have no health insurance for now, we cannot go do a bunch of really expensive tests.
Thanks for reading, hoping for some feedback. 
Have a wonderful day.

   


   
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: High AHI and Cheyne Stokes respiration, what to do?
I see that both reports show an AirSense 10 is being used. When will the AirCurve arrive?
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
Post Reply Post Reply
#3
RE: High AHI and Cheyne Stokes respiration, what to do?
It's reassuring to hear that your husband's heart function is "fine", and hopefully that evaluation includes left ventricular ejection fraction. The current settings are not working out well, and we need to determine whether there is central apnea present. Hopefully when he had the diagnostic test, it was determined what kind of apnea were detected. Please review the test results and let us know the fraction of obstructive, central apnea and hypopnea that were present. If he has central apnea, which appears likely in these charts, then we need to find a way to get adaptive servo ventilation (ASV) into your hands. ASV treats both obstructive and central apnea, and provides inspiratory pressure support to cause a breath when spontaneous effort is not made by the patient. With the extent of central apnea and CSR in these charts, it is nearly a certainty that ASV will be required.

This Airsense 10 Autoset is currently set to have no EPR (exhale pressure relief). Pressure support is the difference between the inhale pressure and lower exhale pressure. This makes using positive air pressure therapy more comfortable and improves ventilation. The Autoset and Vauto requires that the patient have spontaneous respiration effort, and can enhance that effort, but it is not a ventilator like ASV, and will not treat central apnea. I think it is worth trying some new settings to see if this can be improved. I will suggest Vauto mode with Minimum Pressure 7.0, IPAP max pressure 12.0 and EPR full-time at 3.0. If this work to reduce events, I'll be surprised and pleased.

It will be helpful to look at a zoomed-in view of the flow rate during a period of CSR. This will show us if the breathing oscillation is typical of Chenye-Stokes respiration or some other periodic breathing pattern. Zoom in to about a 4-minute time segment where the respiratory wave is visible and take a screenshot.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#4
RE: High AHI and Cheyne Stokes respiration, what to do?
Hello Sleeprider,
thank you for your answer, I will try these settings tonight .
I ordered a Bi-Pap from Resmed, which I can still cancel since it's delayed. If an ASV would be better. I will try to get the results from his sleep test.
I will attach a 4 min time segment here. 

Looking forward and thanks for your help.

   

Hello Crimson Nape,
my mistake, it is an Airsense 10 Autoset he has been using.

I ordered a AirCurve 10 VAuto BiLevel Machine with HumidAir, ResMed and I have no idea when it will arrive, it is already 1,5 months later than first expected.

thanks for your answer.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: High AHI and Cheyne Stokes respiration, what to do?
Our little test tonight will definitely show if ASV is in your future. I'm pretty sure it is, and a bilevel Aircurve 10 Vauto will NOT resolve the problem. You definitely need a Resmed Aircurve 10 ASV or if you cannot afford that machine, a Resmed S9 VPAP Adapt is the older generation machine that offers the same therapy, but is much less costly since it has been discontinued for quite a few years. There are some lightly used VPAP Adapt machines that can be found. MEANWHILE, please read this reference starting at page 28 to learn more about how ASV works. https://document.resmed.com/en-us/docume...er_eng.pdf I'm sure you will find this very helpful to understand how the ASV works. Most people with problems like what your husband displays, realize an AHI less than 2/hour immediately with ASV at the default settings.

Does your husband use multiple pillows, or a firm higher pillow, or sleep on an incline? If so, some of the apnea may arise from tucking the chin or bending the neck which blocks the airway. Will await your reply to advise further.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#6
RE: High AHI and Cheyne Stokes respiration, what to do?
Hello Sleeprider,

thanks again, I will read the pdf about ASV machines, and I will cancel the order for the Bi-pap tomorrow after our test and your feedback on it.

my husband, Stanlee, does sleep on an incline, for some years now, to alleviate the mucus buildup during the night, we read about this somewhere.
Do you think it would be better to get rid of the incline for the apneas (he will be happy)?
Since the apap kinda takes care of the mucus problem, it might be no problem at all to take away the incline.

As for a pillow, he uses a rather thin soft pillow, like 1 inch thick if you lay down on it.

I don't know if it's relevant but it might be, he is of Chinese descent.



Could you determine from the zoom in if the breathing oscillation is effectively Cheyne Stokes respiration? 

Thanks a lot and kind regards, Cy.

Hello Sleeprider,

I found the sleep report. He only slept for 2 hrs in total that night.
his arousal index 23,3/hr
AHI back sleep 49
AHI other sleep position 27
Obstructive Apnea Index 9,2/hr during sleep
He had no Central apnea
Obstructive Apnea-Hypo apnea during sleep 43,8/hr (44,8/hr during non REM, 40.8/hr during REM sleep)

oxygenation-desaturation index 35,8/hr
average saturation during sleep 92
About the heart function, it states that he was constantly having Atrial Fibrillation
average 86 bpm
it also states that he has Cheyne Stokes respiration

Cardiorespiratory:
Hypopneas are scored when there is a reduction in flow along with a desaturation of at least 3% and/or arousal.
Increased number of respiratory events. Obstructive apnea-hypopnea index: 43.8/h sleep (normal value up to 5/h). Cheyne-Stokes respiration.
Snoring.
Nocturnal saturation values: 29 minutes saturation <90%. ODI 35.8/hr recording. Also frequent desaturations in wake.

kind regards, Cy.
Post Reply Post Reply
#7
RE: High AHI and Cheyne Stokes respiration, what to do?
I was going to post earlier but Sleeprider beat me to it.
Based on the zoom view the periodic breathing could be CSR. there is a time element in the evaluation. We, not being medical cannot offer a diagnosis but the pattern does not eliminate CSR. With the onset of the AFIB I'll suggest a revisit of the heart health, make sure you check the LVEF in the process as your doc may require it as a prequisit for the ASV.. AFIB and CHF (Congestive Heart Failure) are both associated with sleep apnea. CHF patients often have CSR as it is a common association. Here we are looking at it from the apnea side without knowing the current heart health. It is good that you have the good heart health history. By any chance has your husband had Covid? That could be a factor.
I too was thinking ASV in the future. Let's see what tonight brings
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: High AHI and Cheyne Stokes respiration, what to do?
Cyleong, a common problem of people that sleep on an incline is chin-tucking which cuts off the airway. Read this wiki and look at the charts that are examples of what "positional apnea" can look like. As you can see, the apnea are abundant and occur in clusters when this happens. It will help if you observe your husband for chin-tucking or a position that blocks the airway. The wiki shows this is often treated successfully with a soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar The zoomed image does not suggest obstructive sleep apnea, where the obstruction is usually followed immediately by large volume recovery breathing.

Your husband's apnea still looks mainly like complex and central sleep apnea, especially with the CSR being flagged so much. The closeup you provided shows a fairly classical CSR pattern where breathing gradually increases to a point where it becomes hyperventilation, then slowly diminishes into a central apnea with a 30 second duration. The pattern repeats frequently through the night. The mechanism is not fully understood, but during hyperventilation, CO2 is flushed, causing a reduction in respiratory drive leading into the apnea where CO2 builds up and a need to breathe is restored. People with CSR tend to have an abnormal lag-time between respiratory changes and the chemo-receptors that drive respiration. It can also be an indicator of heart failure and other problems. You might want to consider using a recording pulse oximeter to track the frequency and extent of his oxygen desaturation that will occur with this condition until he can be treated. Many who have this pattern require supplemental oxygen during sleep.

[Image: attachment.php?aid=40694]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#9
RE: High AHI and Cheyne Stokes respiration, what to do?
(03-13-2022, 01:18 PM)Cyleong Wrote: Hello Sleeprider,

I found the sleep report. He only slept for 2 hrs in total that night.
his arousal index 23,3/hr
AHI back sleep 49
AHI other sleep position 27
Obstructive Apnea Index 9,2/hr during sleep
He had no Central apnea
Obstructive Apnea-Hypo apnea during sleep 43,8/hr (44,8/hr during non REM, 40.8/hr during REM sleep)

oxygenation-desaturation index 35,8/hr
average saturation during sleep 92
About the heart function, it states that he was constantly having Atrial Fibrillation
average 86 bpm
it also states that he has Cheyne Stokes respiration

Cardiorespiratory:
Hypopneas are scored when there is a reduction in flow along with a desaturation of at least 3% and/or arousal.
Increased number of respiratory events. Obstructive apnea-hypopnea index: 43.8/h sleep (normal value up to 5/h). Cheyne-Stokes respiration.
Snoring.
Nocturnal saturation values: 29 minutes saturation <90%. ODI 35.8/hr recording. Also frequent desaturations in wake.

kind regards, Cy.

Cy, I wanted to deal with the diagnostics separately.  The sleep study determined that the sleep disordered breathing was obstructive, with a majority of events being hypopnea, and confirms Cheyne-Stokes Respiration.  With CPAP the events have become central, and there is more apnea than hypopnea.  There has been zero efficacy demonstrated for CPAP. His events are as bad or worse with CPAP therapy as before treatment started. I have no optimism that the settings I suggested earlier will change this, and you should probably be in touch with his doctor tomorrow to discuss supplemental oxygen until a more appropriate therapy is in place.  

A-fib is not a counter-indication for ASV therapy, but there is a warning for patients with heart failure and less than 45% left ventricular ejection fraction.  An echocardiogram to verify heart function is a common requirement to start ASV.  This is controversial, as more recent studies have not shown LVEF < 45% is a repeatable risk factor, and these patients benefit from treatment of CSR and central apnea. You will read in the Resmed Clinical Titration Guide that ASV is effective in the treatment of these conditions, and I suspect would significantly improve his life.  Standard bilevel therapy without a backup rate that triggers pressure support (IPAP) will not work for this condition. ASV is the gold standard, however we often see ST (spontaneous timed) bilevel prescribed with less effective results.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#10
RE: High AHI and Cheyne Stokes respiration, what to do?
3 .5 Years back I was similar and put on a Trilogy 100 Ventilator. Also chf with preserved ef. This is totally treatable, I was able to step down to apap in just under 3 years. Best wishes.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Backup Battery Recommendation for High Pressure and Humidity Johnnyde94 22 2,197 05-12-2022, 02:45 PM
Last Post: sleepyBuzz
  High Leakage but AHI okay BrianG 2 172 05-05-2022, 09:53 AM
Last Post: pholynyk
  Low AHI but pression too high? Artanox 1 178 05-03-2022, 03:43 PM
Last Post: OpalRose
  [CPAP] Waxing and waning respiration / OSCAR charts library? Kobayashim4ru 2 148 05-02-2022, 08:07 PM
Last Post: Kobayashim4ru
  DreamWear nasal Cushion air vent makes a high pitch whistle noise watertrails 9 326 04-24-2022, 02:14 PM
Last Post: watertrails
  Full face mask causing high AHI ellenos 4 315 04-22-2022, 11:59 PM
Last Post: cathyf
  Help adjusting therapy (cheyne-stokes) adm1jtg 17 416 04-20-2022, 09:48 AM
Last Post: adm1jtg


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.