PAP Therapy with HFrEF

[brucemerson]

New to thread and Oscar so please correct me if I should share data differently. Avg AHI 10 over past several months, higher at times.  Wonder if my heart failure with reduced ejection fraction = 35% might be contributing and if ASV appropriate machine. Any help much appreciated.

My screenshot was all messed up.  How do I copy the Oscar screen to my message if not screenshot?

[Crimson Nape]

Hi brucemerson!  -  

To insert an OSCAR image, While in OSCAR's Daily screen, use the F12 key (for a Mac, use the Fn+F12 key... I think???).  Save this image to a place you can find it.  Now while using the Full editor, and not the Quick Reply, look at the bottom of the editor window for, New Attachment.  Select the browse button and navigate to the screenshot you just took and press the Open button.   Press the Add Attachment to the right of the image's listing.  Finally,  you will need to press the Insert Into Post button.

Please review the link in my signature for understanding OSCAR and adding images here.
- Red

[brucemerson]

Thanks Crimson!  Let me try the screenshot attachment and see if anyone has any advice.  Sky high AHI last night and low sleep quality as I've forcefully gotten my usage hours up, even if I'm awake for hours.  Averages over longer times have been AHI 10.  I've wondered about the high min EPAP at 13 myself.
   

[Sleeprider]

Based on these results for ASV, I want you to really try using a soft cervical collar. This pattern meets our criteria for "positional apnea" or chin-tucking. Your EPAP is a s high as it can reasonably go and still provide therapy for centrals and CSR. Our wiki articles show an example of another member with positional apnea using ASV and the before and after results with a soft cervical collar. Please read these! Other than that, I can't understand why you would cap PS max at 8.0. It should be at least 12.0 to resolve any CA. My hope is we ca resolve the positional aspect of your obstructive apnea enough to lower EPAP min to 8.0. Right off the top, my suggestion is mode ASVauto, EPAP min 7.0, EPAP max 15.0, PS min 3.0, PS max 15.0 and the use of a cervical collar.

Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

[SarcasticDave94]

Yes agreed with this suggestion.

Once the Positional Apnea and settings are addressed, then you'll need to see what your leak status is like.

[brucemerson]

Thanks Sleeprider and Sacastic Dave! Lowered chin sounds likely so I've ordered the collar and see how it works when it arrives. The machine had these settings when they issued it but I was having trouble getting to sleep with it on so often took it off early.  I've only recently been committed to getting usage up but still roll around and wake often.  My PCP says he's going to refer me to a sleep specialist but frankly it doesn't seem like medical personnel in our rural area are very familiar with PAP therapy.  We'll start with the collar and then look at setting adjustments.

BTW, I stumbled on this quote from a resmed pamphlet on my machine and wondered if it was relevant to my HF and low EF and why. "ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2–4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea."  Any insight?

[SarcasticDave94]

My echocardiogram in 2017 to get on ASV had my LVEF at 55%, 3 years later with new cardiac doc doing full blown tests LVEF came up at 63%, after 2 years of ASV therapy. Note I have cardiac PVCs and high BP.

I would believe your heart health would be something to ask for the full story from the doc regarding your specific circumstances and ASV. You may be ok with this and ASV. But I'm not anybody's doc.

I think once you're current issues showing in OSCAR are addressed, this ASV can be tuned to much better settings, that makes therapy and comfort a lot better.

[Ratchick]

My understanding is that they found that people with a lower than normal LVEF were at more risk of problems in a study - but there is some dispute as to whether that actually pans out in reality. That said, my docs refuse point blank to put someone with a reduced LVEF onto ASV - thankfully mine is okay and HOPEFULLY, I can start ASV next week, but that's why the LVEF comes into it.

[SarcasticDave94]

Oh yes silly Dave, the flawed SERVE-HF study. Unless you really have a pretty serious heart condition you're not at risk regarding ASV.

[Sleeprider]

I have started drafting a wiki concerning the SERVE-HF and ADVENT-HF studies here: http://www.apneaboard.com/wiki/index.php...nd_Summary

I hope to expand on this, but consider this a first-draft.  It should help you understand the issues in more detail.  As far as the use of ASV with hearth failure, I really recommend you resolve the positional issue and  move to greatly lower EPAP pressure towards default AutoASV settings.  The lower EPAP pressure can greatly help with LVEF and are a major reason for findings in the SERVE-HF study not finding any increased risk for CHF patients.