Therapy Thread - Meech

[meech]

A review of my Oscar data would be appreciated!

My history:  My Apple Watch alerted me to possible apnea.  I shared with my primary doc and he ordered an at home sleep study which showed at pAHI of 31.2, significant Cheyne-Stokes of 35% and Central apneas of 14.9.  It also noted hypoxemia with 29 minutes under 88% and a mean of 90%   

I started therapy at the end of April on a Airsense 11 (APAP 6-15, EPR 3).  That helped some with average AHI dropping to 16.75...14.11 CA, 1.12 OA, and 25.6% CSR.  The therapist then switched me to CPAP 9 fixed with 3 EPR which resulted in 15.32 AHI, .59 OA, 14.12 CA and 26.32% CSR and large leaks of 25%. (So not much difference other than the large leaks.)

Then I was switched back to the original 6-15 pressure with 3 EPR.  I have been on that setting for the last three weeks with average of 12.39 AHI, .8 OA, 10.56 CA and 15.07% CSR.

I was concerned about heart issues related to the CA and CSR, so my primary ordered an Echocardiogram which had some minor issues but nothing that he was concerned about. 

I had read that sleeping on my back could be contributing to the CA and CSRs so last night I tracked my position with the Somnopose app and have included those results in the screenshot below.  I seems that the CA and CSRs are occurring slightly after I turn onto my back.  Looking back over the last few days, I seem to pretty consistently have a run of CA and CSR starting around 7am until I get up.

I am meeting with the pulmonologist in mid-July.  She has ordered a followup oximetry test which I will do before our appointment.  

Any comments or suggestions that I should discuss with the pulmonologist would be most welcome.

   

[SarcasticDave94]

Welcome to Apnea Board,

There's a few possible things to be aware, some that OSCAR shows. Obvious, there's a lot of CA and CSR flags that final 1/3 of the night, roughly about 05:50 onward.

CSR is referring to Cheyne-Stokes respiration, which depending on your heart health means one of two things. If you have some heart conditions like Congestive Heart Failure, these CSR flags are more likely accurate. If however you don't have any major heart issues, then these CSR flags are false, more likely indicating variable breathing.

So question 1: what heart condition do you have? These would be pretty much known already, because you'd have been to the cardiologist about it. Your heart health would be shouting about something. You're very likely not needing to take a guess here.

Next, the Central Apnea: if I'm reading you right, the test said you have 14.9, that's as in 14.9 cAHI, that being just the Centrals. Right so far?

And then the pAHI 31.2, might that have been overall or just the Obstructive Apnea?

Here's the scenario. You had a moderate significant level of CA. I just don't know if they add up to about half your overall events on the test. What I do know is this, you're not wanting to accept OSCAR charts like this.

Neither your events or leaks in that busy section were decent. It's possible some of this might be a Positional Apnea pattern, but the fact of the elevated CA on the test won't allow me to simply call this PA and be done.

Here's an edit to try at least for a bit next time. Fishing to see what you do on static pressure. Maintain the current mode APAP, but set both min and max to 10. Leave Ramp off. EPR off. Also consider the difference between standard and soft response, you may want to demo both.

If straight pressure is worse in any way return to current.

My thinking is you have some extra sensitivity to having Central Apnea, even before CPAP, and the CPAP makes it even worse. You might be headed to ResMed AirCurve ASV because of these Central Apnea, but there's the above issues that's not yet confirmed.

[meech]

Thanks SarcasticDave94

This is the note from my doc regarding the Echo

Overall, this echocardiogram is not concerning at all. Due to how the images were taken, some views were not seen. But I'm not worried at all. Of course, feel free to make a phone visit if you would like to talk more
 Summary: 
 1. The visually estimated ejection fraction is 60-65%, which is normal.
 2. The cardiac rhythm is normal sinus rhythm with premature ventricular contractions.
 3. Unable to make LV chamber and wall measurements due to lack of parasternal images.
 4. The left atrium volume index is mildly enlarged.
 5. Unable to assess aortic root or ascending aorta due to lack of parasternal windows.
 6. Mild aortic regurgitation. 

I'm not sure this covers everything, but my understanding is heart failure can contribute to CAs and CSRs and with my normal ejection fraction and no edema or shortness of breath I don't think I have that.  And I have never been told I have any other heart issues.
 
Below are the results from my sleep study.  I'm not quite sure if I am reading them right but i think the total AHI is 31.2 and the CAs are 14.9. I dont see anything that calls out the OSA separately.  I don't know if deducting the CAs from the total is the obstructive apneas.

The Pulmonologist did suggest I might need as ASV machine and wants to discuss at our appointment.  I guess at this point I am trying to figure out if these are real CAs and CSRs.  I also have an appointment with the sleep tech on tuesday so we will see what she has to say.

[SarcasticDave94]

OK thanks, this is helpful.

I am not a doctor, just be aware of this. It's seeming the CSR is not based on a heart condition, but likely these CSR flags are false.

And the info regarding the CA, here's what you have: CA were 114 pAHIc and overall 239 pAHI as I'm reading. So CA are roughly half. And the bonus... Your medical, pulmonologist in that case, is talking ASV.

The echocardiogram would have been needed to approve ASV anyway, so that step is completed.

ASV is where you're headed then with this additional data. It's similar to your current CPAP. I've used one myself and it's easy to setup.

If me I'd be on the phone, pushing for the process to speed up. Not being negative, but you're probably not improving things as is.

Do note Central Apnea are contrary, they're consistently inconsistent.