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Hypopneas - Central/Obstructive?
#1
Hello,

I have completed my 20th day of APAP therapy. I have felt better, but I think there is still much to be improved, based upon the data that follows.

I was diagnosed in July with OSA, with 19.4 untreated events per hour. Here are the other numbers:

Central Apnea Index - 1.3
Obstructive Apneas 0.0
Mixed Apneas - .3
Hypopneas - 17.7
AHI - 19.4
RERA's - 2.0
Total Respiratory Disturbances - 21.4

The Polysomnography Report specifically states that it does not include CSR Breathing, Hypoventilation, or Periodic Breathing.


I am wondering about the OSA diagnosis, in the absence of the CSR and PB data. Most of my AHI each night is made up almost entirely of hypopneas. My 20 day HI is 3.77, while my Obstructive Index is .21. Here are the other numbers, as reported by Sleepyhead:

Overall AHI - 4.45
Clear Airway Index - .47
Flow Limitation Index - 1.03
RERA Index - .21
% of time in Cheyne-Stokes Respiration - 2.94
(my PR 560 APAP lists my 30 day Periodic Breathing at 6.0)

Average leak rate 1.88
90% leak rate - 6.0
% of time above the leak rate threshold - 1.09

Average pressure - 5.38
Min pressure - 4.0
Max pressure 10.30
90% pressure - 7.2

I have several questions based upon this data:

1. How do you separate the central hypopneas from the obstructive hypopneas in Sleepyhead? What graphs do you look at?

2. I am concerned about the number of hypopneas each night. There are generally close to about 40 each night. How do I reduce them? If they are central hypopneas, I would imagine that I would need an ASV machine. Is this correct?

3. I am concerned about the Cheyne-Stokes Respiration scores each night. I have read about the implications. I imagine that these scores include hypopneas. Would they definitely be central hypopneas, or could they include obstructive hypopneas?

4. My Periodic Breathing scores from the APAP machine are always higher than the CSR scores in Sleepyhead. At what %, should I be concerned about these scores? Or, should I simply be concerned about any CSR/PB scores?

5. Finally, I was diagnosed with OSA. Based upon the recent data, wouldn't it be more accurate to describe this data as Mixed Apnea, or even Complex Apnea?

Thanks so much for any insights that you can offer. The Apnea Board is an amazing resource. I have already benefited greatly.

I have a meeting at the Sleep Clinic in about 10 days. I want to be informed as possible. At this point in time, based upon what I have learned, I will look into an ASV machine, to address the CSR/PB.

Thanks in advance....
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#2
1. Hypopneas don't happen with Central apnea. Hyopnea is the decrease in flow, at least 30%, for at least 10 seconds. With Central Apnea, there is no decrease, there's just cessation of breathing. This is why the number of hypopneas are taken into account for the diagnosis of Obstructive Sleep Apnea.

2. You decrease those hypopnea by increasing the pressure. It usually does not take much of an increase, just a half point or so. But yours is set to wide freakin' open so you are probably having so many because the machine is having to work so hard to get there. My suggestion would be to look at the data and narrow that range. Look at the median pressures over the past 20 days and set the minimum to the least one. Then look at the 95% pressures and set the maximum pressure one or two above the highest of that. If that range is really far, then look at what 95% happened the most and go one or two above that one. Live with that for another 20 days, gathering data, the see what happens.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#3
Good information ... thanks ...
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#4
I received the PR 560 already set wide open from 4 to 20.

Three weeks later, I am going to tighten the range from 5 to 10, and see what happens for the next few weeks.

Most of my nightly average pressure scores are between 5 and 6.
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#5
(09-07-2015, 04:14 PM)xdocgx Wrote: I received the PR 560 already set wide open from 4 to 20.

Three weeks later, I am going to tighten the range from 5 to 10, and see what happens for the next few weeks.

Most of my nightly average pressure scores are between 5 and 6.
Maybe, 6 or 7 - 12, as 90% pressure 7.2 and max pressure 10.30
Flex setting is something, you'll have to experiment with
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#6
(09-06-2015, 05:17 PM)PaulaO2 Wrote: 1. Hypopneas don't happen with Central apnea. Hyopnea is the decrease in flow, at least 30%, for at least 10 seconds. With Central Apnea, there is no decrease, there's just cessation of breathing. This is why the number of hypopneas are taken into account for the diagnosis of Obstructive Sleep Apnea.

Central hypopnea does exist, but you won't see it on any of the reports from a CPAP machine, or probably not even on a sleep test. It's hard to measure, so the term is rarely used, at least at present. They generally say "hypopnea," and don't bother to say "central" or "obstructive."

Central apneas may be a waxing and waning of breathing without completely stopping, for instance CSR/PB. Some of these meet the definition of hypopnea.

You probably don't want to worry too much about the %CSR/PB numbers. Worry about the AHI numbers. If the PB is severe enough, it will show up as AHI.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#7
The manual does not say what % of period breathing is acceptable but say "No therapy adjustments are made in response to periodic breathing"

The machine increase pressure in response to snoring and flow limitation, both are signs of obstructive events, not central events
I guess, hypopnea is obstructive if flow limitation proceeded such event
Avoid sleeping on your back, may helps

Certain medication and few glasses of Champagne or something else, may cause numbers to jump all over the place
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#8
I'm with Zonk. Run the pressure 7-12 and try wearing a backpack stuffed with 3 tubes of tennis balls.

Sleep-well
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#9
(09-07-2015, 04:57 PM)archangle Wrote:
(09-06-2015, 05:17 PM)PaulaO2 Wrote: 1. Hypopneas don't happen with Central apnea. Hyopnea is the decrease in flow, at least 30%, for at least 10 seconds. With Central Apnea, there is no decrease, there's just cessation of breathing. This is why the number of hypopneas are taken into account for the diagnosis of Obstructive Sleep Apnea.

Central hypopnea does exist, but you won't see it on any of the reports from a CPAP machine, or probably not even on a sleep test. It's hard to measure, so the term is rarely used, at least at present. They generally say "hypopnea," and don't bother to say "central" or "obstructive."

I did some quick research before that answer and the only hypopneas I could find in relation to Central Apnea was for daytime central events for those who have certain neuro conditions. I couldn't find anything that mentioned it for Sleep Apnea. I was surprised at that, actually. So thanks for letting me know! I'll have to do some indepth research into it later.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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
Dr. Michael Berthon-Jones talk about central hypopnea (before S9 AutoSet central apnea detection) in this newsletter ... http://www.resmed.com/au/dam/documents/a...0906r1.pdf
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