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Mixed/complex apnea question - edwardre - 08-03-2016
Greetings one and all. First post. First post ever for any forum, as newbie as it gets for seeking advice.
My name is Ed and although I'm a new to this experience I'm not new to CPAP therapy, I've been sleeping with a CPAP since 1992. Anyway, my machine has recently gone belly up - that is to say it works for about 40 minutes then starts to emit a high pitched whine (sounds like bearing noise to my untrained ear), pressure starts to fall and within a few minutes it's not blowing air. When trying to acquire a replacement I was told I needed a new sleep study. At the time this really frrustrated the bejesus out of me with the rationale that if the hose develops a leak, they send a new hose so why cant they just send a new machine? That's not why I'm writing, just some background to paint the picture.
After a lot of grousing I finally went for another study - what a difference in testing methodologies a quarter century makes. As you all are aware nowadays instead of (for example) "you have 100 apneas per hour average, your perscription is 10", there are obstructive, central, complex, hypopneas of several flavors, etc. I'm glad I went and got retested.
My sleep architecture includes 19 osa's, 42 csa's, 16 mixed sa's, 27 oh's averaged per hour. During the CPAP/BiPAP portion of the study, 16 osa's, 114 ca's, 5 mixed, 5 oh's. In doing some research, these numbers tend to indicate the need for perhaps an ASV machine - EXCEPT - I suffered a heart attack a few months ago complete with Congestive Heart Failure - which I also read that there is a warning NOT to use an ASV if you are a congestive heart desease patient.
So that begs the question, what is the treatment options for someone like me now that the device that seemingly will help with the severe CSA and complex apneas is off the table for folks in my shoes? I have a first doctors appt since receiving the sleep study results in 2 days, I'd like to be able to go in telling him "I'd like you to perscribe this machine or that", so the equipment provider doesn't try to stick me with a basic CPAP machine and shoof me out the door.....any advice is greatly appreciated. Or am I working myself into a lather unnecessarily?
RE: Mixed/complex apnea question - DeepBreathing - 08-03-2016
G'day edwardre, welcome to Apnea Board (and to the internet
)As I understand it, the concern about congestive heart failure arose from a long term trial by Resmed in which patients with CHF were seen to have a higher mortality on ASV therapy than without the therapy. The percentage of affected patients was small, but significant enough that Resmed terminated the study. Apparently it applies to patients with CHF and a left ejection fraction lower than 45%.
http://www.resmed.com/us/en/consumer/newsandinformation/news-releases/2015/resmed-provides-update-on-phase-iv-serve-hf-study-of-adaptive-servo-ventilation-therapy.html
In your case, I recommend you consult with your doctors as a medical team and weigh up the risks of continuing with severe central apnea against the risk of an adverse outcome from the therapy. I don't think there's any easy answer here, it a matter of risk management and getting an holistic view of your total medical situation.
Good luck!
RE: Mixed/complex apnea question - richb - 08-03-2016
DeepBreathing pretty well sums up the problem for those with Central Apnea and Congestive Heart Failure. There is a Scholarly Article that suggests that Central Apnea is a beneficial adaptation to CHF and that treating CA removes that benefit. Take a look. https://www.sciencedaily.com/releases/2015/09/150901115227.htm
Rich
RE: Mixed/complex apnea question - edwardre - 08-03-2016
Thank you both for your input. DeepBreathing does indeed reference the warning I was referring to, I forgot to mention that my left ventricle EF as a result of the heart attack is now <20%. Likewise thank you richb for the additional link, taking the article to its next step and perhaps a litmus test of their given hypothesis, as they (hopefully) successfully treat my CHF - by that I mean treat the EF issue by several therapies designed to increase my low EF towards 45% and/or above, that the instances of CSA should decrease commensurate with the decase in severity of my CHF.
And then taking it one more step, sounds like I/they should ignore the CSA and complex apneas for now and continue to treat the OSA by standard CPAP therapy, monitoring closely to ensure that the frequency and severity of CSA do indeed decrease as the CHF is addressed. Right? I am ok with that and am ok with suggesting the latest CPAP device, putting me in the group that I see so many otheres in currently, deciding between the Phillips Dreamstation or the ResMed 10.....
As far as consulting with my doctors as a team, certainly I hope that's exactly what will occur. However I have little faith in their (his) exposure to sleep apnea and its treatment in general as I'm having to go through my primary care physician for the script/referral, there is no designated respitory specialist involved. In fact I have found that the whole topic of SA in general is treated more as a footnote to the heart issues rather than a potentially key component of overall health. Whilst in the hospital for a month, their attitude was almost flippant when I mentioned that I need a CPAP machine, that I have used one every time I sleep for a quarter century - literally half my life - and that I was uncomfortable going to sleep without it. By flippant I mean they told me "yeah, you're welcome to have your wife bring it in if you want to".
Thanks again for your support and inputs.
RE: Mixed/complex apnea question - richb - 08-03-2016
Sounds like you have a plan. You can also do some additional research on CHF and Central Apnea. It seems that the association between the two conditions has drawn a lot of research but the reason for the association is poorly studied. The link that I provided has one of the few attempts at explanation. You may find that successful treatment of CHF and low EF reduces or eliminates your CA and that you can continue with traditional CPAP therapy without ever needing an ASV machine.
Rich
RE: Mixed/complex apnea question - Possum - 08-03-2016
(08-03-2016, 10:18 AM)richb Wrote: DeepBreathing pretty well sums up the problem for those with Central Apnea and Congestive Heart Failure. There is a Scholarly Article that suggests that Central Apnea is a beneficial adaptation to CHF and that treating CA removes that benefit. Take a look. https://www.sciencedaily.com/releases/2015/09/150901115227.htm
Rich
Fantastic contribution, richb! Since I'm a scientist, I'm always pleased to see people referencing actual scientific / medical literature.
RE: Mixed/complex apnea question - edwardre - 08-03-2016
Thanks again richb. I guess I existed in blissful ignorance since '92. At that time there were not any choices of machines, no options, nothing. You either accepted the machine they provided and made it work for you or you continued to suffer without any CPAP assistance. One mask configuration - nasal - in sm, med, lg only. Certainly there was no internet forum(s), in fact you'd be hard pressed to find anyone anywhere that heard of or knew what SA was. No heated tube, no humidity. Wasn't 'invented' or thought of yet. At that time there was 2 sleep study labs on the entire west coast, one in LA and one in Portland OR. In my case I travelled to Japan twice a year on business, and everytime I went through the airport with my cpap machine in my luggage I was pulled aside to a back room my luggage tore apart and several additional security officers called in for a conference until they determined the machine was not a threat to the other passengers.
Back then the respitory specialist community was very attentive. I recall I had my study and by the time I got home from work that day there was a cpap machine and a technician at my house ready to fit and set me up. Nowadays, I've been without a working machine for going on a month, no sense of urgency from the doctors. Crazy.
Blissful ignorance in a simpler time.....Now....sheesh....!! A zillion options and apnea is a household word. Crazy.
RE: Mixed/complex apnea question - trish6hundred - 08-03-2016
Hi edwardre,
WELCOME! to the forum.!
Much success to you with getting your CPAP machine problems straightened out.