Peripheral Vascular Disease and apnea?

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Peripheral Vascular Disease and apnea?

Postby shreck » Fri Nov 04, 2005 2:35 am

Trying to find info,

I don't even know if there is such a thing as "Peripheral Vascular Disease". What I do know is, that Apnea has caused my legs to look as though I had Peripheral Arterial Disease, but my legs suffer from a vascular problem, not arterial. I have had every symptom of PAD that I am aware of, including blood clots. I am 45 yrs old and I have had mixed apnea all my life.

I am looking for more information, my doctor has been less the forthcoming about the subject. Seems to be more comfortable to just treat symptoms, then to be upfront and proactive. Is there any Hospitals or Groups that specialize in "PVD" or in apnea with significant side effects.

Thank you
Bill
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Re: Peripheral Vascular Disease and apnea?

Postby Daniel » Fri Nov 04, 2005 4:32 am

shreck wrote:Trying to find info,

I don't even know if there is such a thing as "Peripheral Vascular Disease". What I do know is, that Apnea has caused my legs to look as though I had Peripheral Arterial Disease, but my legs suffer from a vascular problem, not arterial. I have had every symptom of PAD that I am aware of, including blood clots. I am 45 yrs old and I have had mixed apnea all my life.

I am looking for more information, my doctor has been less the forthcoming about the subject. Seems to be more comfortable to just treat symptoms, then to be upfront and proactive. Is there any Hospitals or Groups that specialize in "PVD" or in apnea with significant side effects.

Thank you
Bill


Hi Bill,

Have you been diagnosed with apnoea, or do you just suspect that you have it ?

Were your 'other' problems checked out at the time of your sleep study ?

I have never come accross specific vascular problems, but untreated apnoea can be responsible for many conditions.

If you have not been diagnosed yet, I suggest a good teaching hospital (or University hospital) with a sleep clinic to start with.

Daniel
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Postby shreck » Fri Nov 04, 2005 1:43 pm

When I was 28, I had my first sleep study and was diagnosed with "mixed-Apnea" in 1988. I have no specs related to the test to share, except that they told me I was waking up every 15 sec. Shortly after I had surgery that removed my tonsils and enlarged the roof of my mouth by removing the punching bag. That cured 3 major symptoms; falling asleep while driving, "vivid dreams" or "nightmares" and bed wetting. The only side effect was the tendency to have water run out my nose while drinking from a fountain.

Within 6 months of the surgery I developed high blood pressure. About 2 yrs after the blood pressure went up, had my second sleep test. This time the doctor recommended a surgery to straighten my nasal passages. That surgery did squat. Shortly after the second surgery I was introduced to my first cpap. It was set at 10 and it was a constant pressure machine with a mask for my nose. But I sleep with my mouth open most of the time and when it opened with the machine on (OMG), I felt like Godzilla shooting out his radioactive blast out his mouth. The cpap being a constant pressure type and I never was able to adapt to it and fall asleep on a regular basis. (now days falling asleep with my full mask is so easy, I don't even need the ramp)

In the 10+ yrs that followed, (before finally getting another sleep study and a decent machine) I became a coffee w$@# in the morning (now I'm just a coffee snob) and I developed other physical symptoms. Mainly what I posted about, one symptom related to that was difficulty urinating in the morning. I know now that it was the apnea, because on the nights I sleep with my cpap, I have no more problems in the morning and vise versa. But at the time, it created some prostate worries. Since that time I have had yearly physicals and no prostate problems or diabetes were ever found.

The other symptom was my legs have almost turned brown up to my calf, I developed a heavy left leg (that I thought was just a back problem) and even with the use of a cpap, my right leg is starting to get heavy too and I get moderate cramps in both legs after too much walking. 1 yr ago I developed blood clots in my left leg, but my doctor missed diagnosed my first visit and just prescribed a diuretic for the swelling, 2 weeks later the clots spread to my lungs. All of these are symptoms of PAD (Peripheral Arterial Disease), finally my doctor told me that my sleep apnea has put pressure on my vascular system within my legs (hence the "PVD) and caused the poor circulation, the symptoms that look like PAD and increased my risk of blood clots. The only good news was my poor circulation wasn't caused by a plaque build up (PAD).

But as usual it seems like I'm only hearing "the tip of the iceberg" from my doctor, so I am trying to find out more info myself.

Bill
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Postby shreck » Fri Nov 04, 2005 10:43 pm

3 weeks ago I met someone else, 4 yrs younger than me, with the same leg problems as I have. I know there are answers out there, the only ones I have found so far are tecnical research papers that make the link of PVD and Apnea.

Does anybody know in laymans terms?.
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Peripheral Vascular Disease and apnea?

Postby struggling » Sat Nov 05, 2005 12:23 am

Dear Shrek, I am struggling too.

I have a post going about feeling worse after starting sleep apnea--it is the one 3 months after CPAP short of breath....

Anyway, the OTHER symptom that I did not mention was pitting adema in my legs (swelling that when you poke it, the indentation stays there). I was told, because it got better, that it was unrelated to sleep apnea, but I have never, ever, had anything like it--I am thin (at least for my age). My other symptoms are painful breathing and shortness of breath, which they think are asthma, but that does not explain the swelling. So your experinece makes me think that there really is a piece of this that is unexplored.

I did a library of medicine search for you. Unfortunately the best study is done by a group in Israel. Basically they say that apena is associated with narrowing of the blood vessels--at least at the time of the apnea. They report: "In 42 patients with Obstructive Sleep Apnea Syndrome (OSAS) profound, transient vasoconstriction and tachycardia usually of a periodic nature, were clearly seen with each apneic event, possibly related to transient arousal. Sleep. 1999 Nov 1;22(7):939-46. Periodic, profound peripheral vasoconstriction--a new marker of obstructive sleep apnea. Schnall RP, Shlitner A, Sheffy J, Kedar R, Lavie P.

There are only six studies!! Suggesting that this is the new frontier. Keep after it.
suggestions: is your apnea fully under control? Do you have a machine that can give your doctor a data dump so that they know if you are fully covered.

Do you sleep holding a single position because of the CPAP, and therefore do not have the regular motion that keeps your blood moving around as you sleep?
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Re: Peripheral Vascular Disease and apnea?

Postby shreck » Sat Nov 05, 2005 4:04 am

struggling,

Those are the same symptoms I had when I was diagnosed with blood clots in legs and lungs, very dangerous, not something to take lightly. I had the clots in my lungs for 3 days that I know of and most likely the clots in my left leg were there at least 3 weeks prior. I thought there was just some sort of respiratory infection in my lungs, I was very wrong

Please see a doctor ASAP,

if they're blood clots and you wait for any other symptoms to show, it could be your last. At the very least it sounds like a Doctor would prescribe you some compression stockings for your legs and have you elevate them a couple times a day.

struggling wrote:

"is your apnea fully under control?"

"Do you sleep holding a single position because of the CPAP, and therefore do not have the regular motion that keeps your blood moving around as you sleep?"

"Do you have a machine that can give your doctor a data dump so that they know if you are fully covered".


I wish,

you would think that with apnea I would fall asleep easily, but the reverse is true. I manage to fall asleep with the mask about 5 of 7 days a week and usually I'm lucky to get 6 hrs rest. The nights that I'm most tired, are the most difficult to keep the mask on.

The poor circulation through my lower extremities was caused by doing nothing about the apnea for aprox. 12 yrs. (the time between my first cpap in 92' till my I received my new one April 04')

They make a cpap machine that will monitor my sleeping too?, mine only keeps track of hrs. They never finished my sleep study last year, I had to tell the tech what my old cpap was set at. I found out real fast, that the old setting wasn't enough. So at this point I have no idea what is the ideal pressure for me. It's at 12 now and I had been thinking about getting it raised. I would really appreciate any info you have on that new type of cpap.

Thank you for your help and please take care of yourself too.

Bill
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PVD and SA

Postby sleepydave » Sat Nov 05, 2005 7:14 am

Hi Struggling and Shreck:
I do not believe that OSA causes PVD directly.

Here's a pretty good article about PVD:

Peripheral Vascular Disease

Now, it may be that if you have underlying cardiac problems, then you may end up with Central Sleep Apnea (that you have some degree of Mixed Apnea kinda suggests this). If you can dig up your sleep studies we can take a closer look at this.

But certainly, if you have PVD, and by some unlucky fate you also have OSA, then yeah, now you have something that really aggravates the hypertension.

For that matter, if you have CSA causing significant desaturations, it's still an issue.
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Peripheral Vascular Disease and apnea?

Postby struggling » Sat Nov 05, 2005 10:59 pm

Thanks for all the support.

I have had a CAT scan and an x-ray of my lungs and all concur I do not have any risk for lung clots--the swelling could be a result of my diabetes medication, actos. The most recent diagnosis for me is asthma, in addition to the sleep apena--but sinutitis is mixed in there too.

best

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Postby shreck » Sat Nov 05, 2005 11:00 pm

That was like many of the other articals that sugest that a plaque build up is the cause. In most articals talk about how apnea puts pressure on the vascular system, but usally they are talking about the heart. It may have done the same with me, except you can see the damage to my legs.

Within the 12 yrs that I ignored the apnea, I have woken up 3 times with an irregular heart beat, can't even begin to estimate how many times I woke up gasping for air or choking with my throat and/or chest on fire from reflux. Urinating in the morning was like someone put a clothspin on my uretha.

I have been trying to collect all my medical records in the last few months, do you have any suggestions on getting ahold of 17 yr old records from a doctor that retired 12 yrs ago. My 2nd study was done at the Pomona Valley Hospital's sleep center. I don't know if the sleep center is still there or not, but I will be checking on Monday.

I will order the results from my most recent study on Monday also, but I expect it to take 2 weeks to get them. (every Doctors office so far, never copied them anyway until I showed up 2 weeks later. Real BS) Then I will post them on this thread for you to look at. TY.

Do you or anybody else know if there is a hospital or medical group within Southren California that is known for having a really great apnea center ?

Thanks sleepydave for the link and Daniel, struggling and dave for your responses.

Bill
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Postby Vicki » Sun Nov 06, 2005 12:15 am

Shrek,

To answer your two question;

1. Pacific Sleep Medicine has great labs and doctors throughout Southern CA. They literally saved my life. If you google them, they will come up. LA probably has some good ones also at UCLA or USC, but I am not familiar with them. I've run across a couple in Westside LA that I would steer clear of.

2. Apnea and PAD is a subject I'm interested in. My Rheumatologist disagrees with me, but I get a bizzare arthritis in my toes and fingers when my apnea is not being compensated. I believe it has something to do with decreased peripheral O2. I will be posting what I found in Interesting Links and there does indeed appear to be a correlation of OSA with PAD.


Vicki
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That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Postby struggling » Sun Nov 06, 2005 6:56 pm

Dear Bill

The new machines DO give your doctor more info about the effectiveness of your CPAP therapy. I have used the goodnight 420 S which records up to 600 sessions of date/time usage data. It also detects persistent residual apnea, hypopnea and snoring events that occur at set-pressure, allowing appropriate adjustments to therapy.

Now I have switched to the S8 ResMed, with a removable data card that has Data Options for Usage, AHI, Events and Pressure, 365 sessions of summary data, five sessions of detailed data.
ResScan Data Card 180 sessions of summary data, five sessions of detailed data.
Menu Display Some data available via LCD menu.

Hope that this helps--because it seems that knowing how effective your CPAP is in your own bedroom is key.

best

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Postby shreck » Sat Nov 19, 2005 12:14 am

Here are the results of my latest test:

Analyzed time: 247.4 min
Index time: 234.5 min

Apnea + Hypopnea (A+H) : 274 70.1/h

Supine A + H: 265 71.3/h

Average oxygen saturation: 88.5%


There was no data for optimal pressure, because they didn't find it before the end of the test. (That is the main reason I'm so interested in a CPAP that can actually monitor its effectiveness) Do I have any recourse on a test that paid for, but not completed?.

I have done my best, trying to locate my original test from 17 yrs ago. I found the doctor that ordered the original test and performed the surgery and to my surprise, he is my current NE&T doctor (he moved locations twice in the last 16 yrs and I only saw him for about a yr. a very long time ago).

What I remember from the original test was that I was having apneas every 15 seconds. That would more than double the current test, But that surgery (17 yrs ago) did eliminate the 3 major symptoms of that time period that haven't reoccurred. The symptoms of the last 12 yrs have turned out to be more severe in the long run, can't imagine how bad off I would be if I didn't have the surgery.
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Postby shreck » Sat Nov 19, 2005 1:01 am

I have a few more questions, after looking at this report closer.

The different levels of sleep (S1, S2, S3, S4, Rem, Wake) The results showed:

% of TST: S1 46%, S2 51.4%

% of sleep period: S1 44.7%, S249.9%, S3 0%, S4 0%, REM 2.5%, Wake 6.9 min.

Within "Apnea/Hypopnea" statistics, what do the terms "Supine", "Non-Supine", "Mean Seconds" and "Longest seconds" mean.

This area also showed that I had: 47% obstructive, 4% central, 19% mixed. I understand that but, what do they mean when I have 30% "Hypopnea"?

I know this is a lot to answer to, is there a link to a site that explains all this?.

Thank you
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Answers

Postby sleepydave » Sat Nov 19, 2005 9:14 am

Hi shreck:
Ok, let me see if I can get all these:

Do I have any recourse on a test that paid for, but not completed?


Probably not, but your insurer may realize that this sometimes happens and authorize another test.

Within "Apnea/Hypopnea" statistics, what do the terms "Supine", "Non-Supine", "Mean Seconds" and "Longest seconds" mean?


Supine is sleeping on your back, non-supine all other positions, mean is the average length of the respiratory events, and the longest is exactly that.

what do they mean when I have 30% "Hypopnea"?


Hypopnea is a respiratory event that has 50-80% reduction in flow, plus an arousal and/or a desaturation, depending on who you talk to. 30% of your events were hypopneas.

is there a link to a site that explains all this?


Sure

Good Link for Apnea Support

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Postby shreck » Fri Dec 02, 2005 4:42 am

Vicki wrote:Shrek,

2. Apnea and PAD is a subject I'm interested in. My Rheumatologist disagrees with me, but I get a bizzare arthritis in my toes and fingers when my apnea is not being compensated. I believe it has something to do with decreased peripheral O2. Vicki


Vicki,

Had something similar happen to me after falling asleep 2 nights w/o the mask a couple nights ago. I had the usual problems from the waist down, but this time when I washed my hands in the morning, I couldn't feel the cold water with my left hand.
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