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Centrals - jpw018 - 02-22-2021

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I have been using ResMed AirSense 10 since Oct 2020. It has been successful in reducing OSA but I have centrals that have either emergered or have been uncovered.

I have noticed a general pattern has emerged (virtually all events are central):

Night 1: AHI below 5
Night 2: AHI between 7-9
Night 3: AHI between 12-15
Night 4: AHI between 15-19
....repeat...

The last two night my AHI was 23 and 28 almost all being unobstructed apneas... those are hopefully an anomaly? Typically tonight would be below or around AHI 5.

My RT set me on a constant pressure 10 in Dec 2020 to try to reduce the centrals I can't say it made much difference. I have not felt the benefit of CPAP since starting although when AHI is below 5 I do wake more refreshed- I know when the numbers are low or high now before looking. It hasn't translated into sustained daytime energy as I was hoping...

My RT is sending me home with an oximeter to see if O2 sats are following- my luck it will be one of my good AHI nights! My Level 3 study last year showed AHI over 40 but not much in the way of O2 desats.

No known cardiac issues- No pain meds. No history of seizure/ or other brain issues.

Is this pattern of "sawtooth" AHI centrals rising then falling familiar to anyone? Does anyone have any advice on what to discuss next with my RT?

Attached is screenshot of last night AHI and a more typical night of AHI 7 from a few nights ago.

Cheers
JPW


RE: Centrals - SarcasticDave94 - 02-22-2021

OK you'll need to ask for the sleep study report info, especially event count and type. Since you've been on PAP from October, this likely rules out treatment emergent Central Apnea. Whatever the proper Canadian process, probably you need to address discomfort and unrest due to CA with your doc. You'll need the doc to consider a ResMed AirCurve 10 ASV for CA combat duty. If you go to BPAP you'll likely find much higher CA so be warned.


RE: Centrals - kappa - 02-22-2021

Did your sleep study look at leg movements? PLMS can trigger hyperventilation, leading to hypocapnia (low blood CO2) and then central Apneas. The second trace seems to show unstable breathing outside a couple of periods which are probably REM sleep.

My CA's are nowhere near as bad, but in this chart you can see correlation of CAs with position changes, as well as with movement where I don't change position (I have a movement sensor on my leg so these are typically twitches every 30-50 seconds). There are also a bunch of pulse rate changes associated with movement.
[attachment=30285]

[This trace is when I had stopped all medication... normally my AHI is around 3 with PLMS of 3-7/h unlike here where PLMS was ~17/h].

Of course it could have nothing to do with PLMS... we're all different so even if traces might look similar they can have different root causes...


RE: Centrals - jaswilliams - 02-25-2021

jpw018,


Are you at altitude ? or not as altitude can contribute to Central Apnoea


RE: Centrals - Sleeprider - 02-25-2021

Central apnea is consistently inconsistent. I'm curious what your sleep study showed was the prevalence of central apnea and hypopnea vs obstructive. If the sleep study even hinted at CA with mainly hypopnea events, I think I know your answer.


RE: Centrals - SarcasticDave94 - 02-25-2021

Shall we say Central Hypopnoea?

Beware the purple ink is going to run out soon.


RE: Centrals - jpw018 - 02-25-2021

Thanks for the replies everyone. Very helpful insights.

I didn’t have a leg movement sensor on the level 3 test. The traces do look quite similar? I will mention that to my RT when I see them next.

I am at elevation 2200 feet- I don’t think that would be considered at elevation for centrals? Or would it?

I haven’t located my initial study. It is around here somewhere... It did show AHI 40ish. Yes there were some centrals but mostly Hypo and Obstructive. Quite a few hypo’s if I remember correctly. My O2 sats didn’t drop too badly which surprised me a bit.

I really do appreciate everyone’s thoughts. I am still working with the respiratory clinic on this- they added an O2 sensor to the machine for tonight. Will see what they suggest from here.

Cheers