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RE: Does the infarction affect the breathing in the device?
Not having attached screen shots for well over a year now, it seems to me that this has become a more complicated process than before? I have had to preview my post before being able to 'choose file' and then have to 'attach' and then 'insert' into my post before it happened. Correct me if I remember wrongly but it used to be just one click.
Also lech, if you take a screenshot (F12) in a mac or go to 'view' and select 'take screenshot' and follow the prompts when you post a reply in order to attach the screenshot. Apologies if you have PC but mine has given up and I only have access to a mac now. Perhaps others will chime in to inform on how to take screenshots from a PC, if you require..
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.
RE: Does the infarction affect the breathing in the device?
While the blood test results were interesting and show a number of your results are abnormal suggesting infection and possibly diabetes, it was the detailed daily charts I was hoping to see. You finally came through! By the way, a screen shot can be obtained on your computer by pressing F12, and it will be stored in your OSCAR Screenshot files under My Documents. Let's talk about your updated results from the CPAP machine.
You have experienced a significant change in your therapy that may be related to cardiac infarction. In the historic results from 2017 you had an acceptable level of mainly obstructive events. Your therapy was overall pretty good and minor changes would have been sufficient to optimize your results. Your more recent results are far more alarming, and suggest a significant change in your heart health has taken place. You are experiencing long periods of Cheyne-Stokes Respiration (CSR) which is common with individuals in heart failure. This is accompanied by predominantly central apnea. CPAP will not likely treat this condition effectively, but we may be able to improve your results with some adjustments. The ideal treatment for your current condition is to use an Adaptive Servo Ventilator (ASV) if your heart is healthy enough. The criteria for using ASV is a left ventricular ejection fraction (LVEF) greater than 45%. So this is a question you can ask your cardiologist. If your LVEF is less than 45% as a result of cardiac damage from your heart attack, then a Bilevel ST or iVAPS may be a safer technology to relieve the central apnea. The newest ADVENT-HF study of ASV is encouraging because it shows ASV is an effective and safe therapy in heart failure patients. All of these machines are capable of doing the work of respiration and helping you breathe when you do not spontaneously take a breath. ASV is a method of providing positive pressure to support the airway and prevent obstructive apnea, but the machines provide pressure support in the amount needed to also treat CSR and central apnea. So with ASV your AHI would drop to nearly zero, and you would avoid the complications of persistent oxygen desaturation that you are likely experiencing with CPAP.
Since most of your apnea is now central, and is combined with CSR, your use of CPAP pressure and EPR need to be modified. Your current settings are 6.0 to 13.0 with EPR at 3. You may be able to reduce the frequency of central apnea by changing your settings to 6.0 to 10.0 with EPR OFF or at 1. Reducing maximum pressure and reducing EPR may help reduce central apnea, while still addressing obstructive events. You need a new sleep test and professional help in obtaining the correct machine. This kind of change in sleep disordered breathing is unfortunately common with heart damage, and using your old prescription and approach to CPAP therapy will not likely work. I'm sorry to deliver this bad news, but hopefully you will be able to get the help you need. Here are some links to articles that may help you do more research before talking with your doctor. Please note, your therapy has significantly changed since the heart attack and you must work with a pulmonologist and sleep specialist to obtain appropriate therapy.
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.
06-02-2019, 11:12 AM (This post was last modified: 06-02-2019, 01:57 PM by Sleeprider.)
RE: Does the infarction affect the breathing in the device?
Here are some screenshots and thoughts from your uploaded data. First, this is classic Cheyne-Stokes Respiration. We see regularly spaced respiration that gradually increases and decreases in flow rate with a long central apnea between the respiration. These central apnea all last 20 to 30 seconds. There are a number of OA events that are flagged, however these are actually central event and are nearly identical to the CA. In most cases, a CA can be confused with OA by the machine as a result of respiratory "stacking". This occurs when the lung is full and cannot accept more air, so the machine interprets this as an OA. This is fairly common in CSR. As you can see in the graphs below, during any apnea, the mask pressure does not rise, but stays at EPAP pressure (pressure minus EPR). You need a machine that will trigger a breath by detecting the apnea and automatically triggering higher pressure sufficient to make you breathe.
With this many apnea, and poor respiration from Cheyne Stokes, there is a high risk of oxygen desaturation. I would consider it rather urgent to evaluate your oxygen levels during sleep and consider mitigating problems with supplemental oxygen until an alternative therapy can be devised. One thing that is surprising is that this is a fairly recent problem for you, and really started getting much worse about mid-May. What changed in your health then?
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.
Etiology
Cheyne-Stokes respiration is a specific form of periodic breathing (waxing and waning amplitude of flow or tidal volume) characterized by a crescendo-decrescendo pattern of respiration between central apneas or central hypopneas. The American Academy of Sleep Medicine (AASM) recommends to score a respiratory event as Cheyne-Stokes breathing if both of the following criteria are met:
There are episodes of at least three consecutive central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude with a cycle length of at least 40 seconds (typically 45 to 90 seconds).
There are five or more central apneas and/or central hypopneas per hour associated with the crescendo/decrescendo breathing pattern recorded over a minimum of two hours of monitoring.
Unlike obstructive sleep apnea (OSA) which can be the cause of heart failure, Cheyne-Stokes respiration is believed to be a result of heart failure. The presence of Cheyne-Stokes respiration in patients with heart failure also predicts worse outcomes and increases the risk of sudden cardiac death. Despite increasing recognition and growing knowledge, Cheyne-Stokes respiration remains elusive, and patients have very limited treatment options.
Treatment / Management
The main cornerstone of management of Cheyne-Stokes respiration is optimizing the treatment for the trigger factor, congestive heart failure (CHF), or stroke. The American Academy of Sleep Medicine recommends that positive airway pressure should be considered for all patients with central sleep apnea. The two main modalities of noninvasive treatment for Cheyne-Stokes respiration are continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV).[8][9][10][9]
CPAP delivers continuous positive pressure and has several mechanisms of actions. The positive pressure keeps the upper airway splinted during the central apnea, leading to stabilization of respiratory drives and improvement in oxygenation and ejection fraction. The positive pressure will also reduce the preload by reducing the venous blood flow to the right atrium and afterload by increasing the intrathoracic pressure, thereby improving the ejection fraction. In a clinical trial, CPAP therapy in patients with Cheyne-Stokes respiration showed improvement in nocturnal desaturation, Left ventricular function and six-minute walk distance, but there was no improvement in survival.
Adaptive servo-ventilation is the newer modality of noninvasive treatment which is effective and well tolerated by patients. This mode of noninvasive ventilation can counteract hyperventilation during the hyperpnea phase and prevent hypoventilation during the apnea phase. It delivers constant continuous pressure and can recognize apnea or hypopnea and adjust pressure support with backup ventilation if needed to deliver preset tidal volume. During the hyperventilation phase, the pressure support is reduced, depending on the patient to prevent large tidal volume. Adaptive servo-ventilation is more effective than conventional noninvasive ventilation therapies like continuous positive airway pressure and bilevel positive airway pressure therapy and has been shown to improve the functional class, cardiac functions, exercise capacity and brain natriuretic peptide (BNP) levels. However, in a recent large clinical trial involving patients with systolic heart failure and Cheyne-Stokes respiration breathing, the addition of adaptive servo-ventilation to guideline-based medical therapy did not improve outcome and increased the risk of cardiovascular death.
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.
RE: Does the infarction affect the breathing in the device?
One thing that is surprising is that this is a fairly recent problem for you, and really started getting much worse about mid-May. What changed in your health then?
RE: Does the infarction affect the breathing in the device?
We are, with very rare exceptions, apnea patients with a desire to help others get the treatment they need and deserve with a combination of education and therapy suggestions.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter
