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Introduction; Periodic Apnea without hypoxia
#1
    I have newly recognized apnea and have finished my first week of CPAP. The forum’s reports about devices and software have been invaluable already.
I want to share a salient feature of my initial CPAP data. Most nights I tend to fall into a periodic breathing pattern despite clear airways. The frequent complete cessation of flow on these occasions (for up to half the time for periods of minutes) appears quite alarming. Yet I am not obviously symptomatic. Interestingly the oximeter data (CSM50D+) are also somewhat reassuring. In the attached screenshot, the oxygen saturation drops only from 96% to 95% after 2.5 min of apnea in a 4.5 minute window. (The slowish and very irregular pulse is characteristic of my atrial fibrillation, which has been continuous for the past decade or so but still supports a fairly high level of aerobic fitness with no suggestion of congestive heart failure. Pressure from the Airsense 10 CPAP device here was 7 mm inspiration, 5 mm expiration)
With an AHI over 20 prior to CPAP, I am ready to believe that CPAP can improve my quality of life even though I am not markedly symptomatic to begin with. But results like these raise a general question: is apnea necessarily damaging even if it doesn’t much affect oxygen saturation, pulse rate or quality of sleep? I see many reports of bad health conditions associated with apnea, but those reports usually include disclaimers to the effect that the nature and direction of the causal influence is not clear. So: how much apnea is compatible with good health? If there is no general answer, that is itself an answer that might allay some apnea anxieties.

A relevant discussion of CSA without heart failure --Manzhukani and others, ‘primary central sleep apnea’: doi:10.1016/j.jsmc.2013.10.006
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#2
Hi hobanfan,
WELCOME! to the forum.!
Hang in there for answers to your questions and much success to you with your CPAP therapy.
trish6hundred
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#3
If my charts looked like that, I would definitely feel it in a bad way, really bad.

But it's okay for you, as you indicate in your post and in your daily notes.

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#4
Welcome to the forum. You pose an interesting question, hobanfan. From what I have learned, apnea, by definition, is incompatible with good health, period.
That's why an AHI of under 5 was set as the goal for treatment. That doesn't mean I understand what's going on in your situation. Those centrals don't look good to me, yet your saturation hardly changes, as you pointed out. I also wonder what relationship, if any, might there be between your a-fib and apnea. So, I, too, have questions. Perhaps others here will be able shed some light.

David
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#5
Hi hobanfan,

Welcome to the Apnea Board Forum. I have a question. What do the codes PC and SD refer to in the event flag portion of your data?

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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Post from Imgur


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#6
Pulse Change events and Sp02 Drop events that are user definable in sleepyhead.

Looks like the default sttings might be 6bpm change in 8 seconds for PC events and 4% change in 10seconds for SD events. But these can be changed by the user.
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#7
The PC and SD entries were automatically created by Sleepyhead when it imported the CMS50 oximeter data. There are good instructions for doing that on the forum under the title 'Importing_CMS_50D_Plus_oximeter_data_into_SleepyHead'.

The PC line flags significant pulse changes, and the SD flags sudden drops in the SpO2 values. In my record, PC 'events' are happening all the time as expected with fibrillation, but SD events are rare and minor, never dipping below 93.
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#8
Thanks for the clarification hobanfan and klv329. I would want to check the accuracy of the pulse oximeter. Borrow one and do some experiments. Also, hobanfan, do you know if anything was different during the first half of the night when there weren’t any events recorded? Another question hobafan, can you confirm that you do not have Congestive Heart Failure? Lots of questions but we need more information to help you figure out what is going on here.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#9
Thanks, richb, I'll be checking with my cardiologist. I notice that your profile indicates 'idiopathic central sleep apnea'. That diagnosis (idiopathic or primary sleep apnea, which I take to mean CSA that isn't attributable to some other recognized pathology) could fit my case also, although I gather the long-standing fibrillation may have helped set it up (in ways that AFAIK are not well understood!). I'll ask my sleep doctor about that. I gather idiopathic CSA is not common?
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#10
Yes. What I have is very rare. Took a long time to finally get my ASV machine. Your case is interesting and questions have to be answered. I am concerned about the accuracy of your oximeter as well as the other questions I had. I hope you can get this figured out.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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