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[CPAP] Introduction - Printable Version

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RE: Introduction - Knitman - 01-21-2021

SleepriderIt depends. The risk cohort was defined as individuals with CHF and a left ventricular ejection fraction (LVEF%) of less than 45%, and that was a finding that led to abandonment of the SERVE-HF study.  The problem was that study has serious design faults, used an older generation of ASV devices, used therapy settings no longer in common use, and used a cohort that was not titrated for efficacy or verified to have used the machines.  https://pubmed.ncbi.nlm.nih.gov/26836904/  

The mean AHI in the ASV group was 6.6 events per hour which tells you something about how poorly the machines were setup and monitored. The SERVE-HF trial results were widely interpreted as strong evidence that adaptive servo-ventilation was contraindicated for the treatment of central sleep apnea/Hunter-Cheyne-Stokes breathing in patients with heart failure and reduced ejection fraction.  While the primary outcome of the trial was negative, the main reported finding of this was driven by analysis that was not part of the statistical original design of the trial and that could not be explained by any mechanistic analysis from the trial data.

Another study ADVENT-HF has been in progress since 2010 with the specific purpose of documenting any risk of ASV to the cohort of CHF patients with LVEF <45%. https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.790  To date, that study has NOT identified an increased risk from ASV in this cohort, and has identified numerous benefits of treating the central apnea and Cheyne-Stokes Respiration.  The study design is considerably different, and uses contemporary ASV devices and a carefully monitored study.  https://www.advent-hf.com/
YOU: (I wish we could choose which parts to quote.)

So, the risk is hardly as well defined or a black and white issue, as your doctors are presenting to you,

ME:I have not spoken to my Drs about this so I would not have written that I had.

It was something I read in this thread, I think that made me ask both ResMed and Phillips and both advised against it for people with CHF.

COPD is another contra-indication.

LVEF is <40.  The echo showed scarring from heart attack. I have not had one i said but she told me there is such a thing as a silent HA. Later my cardio told me it could have caused by an infection but didn't really elaborate on that. I am normally full of questions but all this happened whilst I was mentally disassociated from life and I didn't take any of it in. It has only been this last year that I have become aware of my situation and read my medical reports. 

Having read your link, it would appear that the OSA going and the CSA still being there, but low, suggests there has been improvement with my heart.

I experience no symptoms of asthma, COPD or CHF and my HBP has been well controlled for many years, 20, and averages 118/64.

I can swim 1300-1500m in  45 mins. I do so 3-4 times a week when not in lockdown. We rae not likely to be out of lockdown till mid February. Because I am a wheelchair user-due to OA and DDD and brain damage which makes me fall without warning, I am unable to do any form of exercise other then swimming.

CSA can be caused by morphine I am told. 

I still need to lose at lest 30lbs and am slowly still losing but it is harder and slower with no exercise.

 and many CHF patients do benefit from the therapy when central apnea or cheyen-stokes respiration is present.  Clearly, some of these individuals suffer greatly when the central AHI is very high. Furthermore, I have queried you about your LVEF in several posts through this thread, and while you did not offer a quantitative response, your description of your current condition and stage of disease, leads me to conclude it is unlikely that you actually match the profile of the "at-risk" cohort with LVEF <45%.  The "advisory" against ASV does not extend to CHF in general, but to a specific group of systolic heart failure patients.

RE: Introduction - Sleeprider - 01-21-2021

I think the bottom line should be we have not seen a need to go to ASV for you. I wanted to let you know there is some disagreement about whether ASV is contraindicated for someone with CHF.

You don't need to quote me. I know what I wrote, just reply to it. I'll understand what you are agreeing or disagreeing with.

RE: Introduction - Knitman - 01-21-2021

The need to quote is mine. I have a terrible memory.

RE: Introduction - Knitman - 02-02-2021

The Cheynes Stokes line has only just started to appear. It doesn't show anything but 0.00. I looked back over earlier reports and the CS line is no on all of them, but showing 0.00.

I vaguely recall being told these things would only show when I had them. I had enquired as to why I ws not showing RERA anymore. Why would CS show when I am not having whatever they are?


RE: Introduction - Sleeprider - 02-02-2021

Keep in mind that CSR on a Resmed can be flagged for any short period if periodic breathing. This is not something to worry about at this point, but you may have had enough oscillation for it to be flagged. It would appear as a green flag in events, probably at the top.

RE: Introduction - Knitman - 02-02-2021

i used to have a lot of periodic breathing on the DS. Still don't know what it is, only that is common in new borns!

I found put last night that sitting too upright is really bad for me. AHI 15. I think because even with the collar my head flops forward. 

So tonight I shall do what I did a couple of days ago and had the back sloping comfortably and my AHI was low. 

I am. more likely to stay asleep for long periods when in that position. Although I now get more or less little pain sleeping on side, my AHI is lowest, but I wake about every 90mins.

Last night I woke first after almost 5 hrs and then not again for a further almost 8hrs! I wasn't pleased as it was 2pm but I didn't wake up at all until then. A high AHI p'd me off.

RE: Introduction - Knitman - 02-02-2021

I found the CS measurement. It was during the two hours after midday that I slept through. You can see how high the AHI is. What I don't egt is that for the first 4.40hrs , my AHI was 2.32 and I must have woke cos the clock starts again and for the next almost 5.20 hours it was AHI 12.94 and the next 2hours after midday you can see I got the CS and an AHI 15.

I just had a 54min nap and my AHI was 12.94 but no CS. 

I shall return to side sleeping tonight.

I have no idea what happened to make my readings rise so much in the position I am used to. I can only think that perhaps in the time I have had the ResMed, I have slept in the astronaut and also for the time leading up to it when I was using the DS CPAP set to auto trial.

Oh and yes I have still been using the collar.


RE: Introduction - Knitman - 02-02-2021

I am of to bed. I feel afraid to sleep but I guess dying in one's sleep is a good death.
Not only are my AHI's thru the roof, for me, but now have a large % of  CS. And this evening my blood pressure is high. It isn't normally. 

I eventually got over the fear of waking and not being able to move at all from the waist down but I have got used to that idea. 8 weeks in plaater showed me what it wouyld be like and it wasn't awful except I'd never keep my weight down. It is a possibilty not a given that I will one wake and not be. able to. move my legs.

However going to bed and being af=rauis one won';t wake is a different matter. It might be good for me, to have it finally over and done with, and in a good way. But what of m y husband? How dreadful for him? And our dogs? We did already talk about this and if ;ossible the dogs will be shown our bodies to help them realise what has happnede.

RE: Introduction - Sleeprider - 02-02-2021

This post is a little dark for me. I hope tomorrow looks brighter for you. Rest assured tomorrow will come.

RE: Introduction - Knitman - 02-03-2021

I slept on my side. I figured out how to make it more comfortable by raising the leg part, having pillow between legs(a hefty memory foam one), still on side, back part flat with pillow behind me so I don't roll onto back. Pillow for my head.

I woke a few times until I got myself settled as above. If I wake tonight I will take PK and wonder why I didn't do so last night. BTW I only have one dose next to bed. This way I cannot take a dose and forget and try to take another. 

My AHI was 1.51.