• Site Supporter

central vs. obstructive hypopneas

This area is for Sleep Apnea questions and general Sleep Apnea Discussions.


central vs. obstructive hypopneas

Postby KoalaMan » Thu Aug 26, 2010 8:07 pm

Amazingly, today when I went in to download my card data, a very nice DME gave me a printout of my first two weeks of therapy on Respironics RemStar Auto A-Flex system 1. I got to see for the first time what is really going on with my therapy, which was very interesting for me.

My obstructive apneas are down to an average of 0.8/hr, which is great, but my central apneas are at 4.7/hr. The hypopnea index is 4.8/hr. I'm still feeling kind of tired, too (better than before, but hardly "perky").

So here are my questions:

1. Is there any simple way of knowing if the hypopneas that I'm having are central or obstructive? Does the APAP machine count both types? (I'm really confused by what I've read about this on the internet.)

2. Is it possible that I could still be having obstructive hypopneas when my obstructive apnea index is now so low?

My baseline (pre-therapy) indices were: central apnea 0.6, obstructive apnea 4.9, mixed apnea 4.0, hypopnea 15.0 (total AHI 24.5). I was a little surprised that at the sleep study my mixed+central apnea index was nearly the same as the obstructive apnea index. It seemed like there was some possibility of a central apnea problem.

I am seeing my doctor next week but I'm curious if anyone else has had an experience like this. It seems like I'm on the borderline of complex apnea. And it seems kind of surprising that my central apnea index *after* therapy (4.7) is basically equal to my baseline central apnea index (0.6) plus mixed apnea index (4.0). That seems consistent with the possibility that the APAP is clearing all the obstructive problems and leaving only the ones which have some central component. That is why I'm curious about the hypopneas. How likely is it that the only hypopneas that remain are basically central in origin too?

Sorry this is so long and complicated but maybe some of you CPAP wizards can see what I mean! Thanks!
KoalaMan
 
Posts: 32
Joined: Sat Aug 14, 2010 8:53 pm

Postby White Beard » Thu Aug 26, 2010 9:54 pm

KoalaMan you have me confused, I do not believe that most PAP machines can detect Central Apneas, or can distinguish between the two different types of apneas! (Central and obstructive) Even my machine which is specifically made to treat Central Apneas, just list apneas and does not distinguish between th two.
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 14.0, min PS 14.0, max PS 24.0, FitLife Mask
User avatar
White Beard
 
Posts: 1504
Joined: Thu Sep 20, 2007 3:27 pm
Location: Illinois
Machine: ResMed VPAP Adapt SV enhanced
Mask: Respironics Fit Life
Humidifier: yes ResMed HumidAire 2iC
Year Diagnosed: 2007

Postby KoalaMan » Thu Aug 26, 2010 11:12 pm

Well, the data printout that the DME gave me distinguishes central and obstructive apneas, but does not distinguish two types of hypopneas. I think I read somewhere that the data reporting for ASVs is less detailed than for the most recent APAPs (although maybe that has changed). Bear in mind, I'm not talking about the machine's display (which tells me only 7 day and 31 days AHI averages). This is a data download coming from the memory card. Is that what you were referring to, White Beard?
KoalaMan
 
Posts: 32
Joined: Sat Aug 14, 2010 8:53 pm

Postby jeffnk » Thu Aug 26, 2010 11:38 pm

Some of the newer machines use reflected waves to determine if the airway is open during an apnea, and then they label the apnea obstructive if the airway appears to be closed. or central if the airway appears to be open. That is not as good as effort belts, of course, but at least it is something to indicate what the event likely was.

My personal definition of "hypopnea" (admittedly a VERY loose one) is "a moment of less-than-ideal breathing." Hypopneas have strict definitions in a lab, but no home machine can be that strict. Home machines see less-than-ideal breathing and then call it hypopnea.

Don't worry about whether hypopneas are central or obstructive, I would say. It doesn't matter, treatment-wise. That is useful information for diagnosis, but not so much for treatment with a home machine. That is my opinion only, and there may be exceptional circumstances, but thinking about whether hypopneas are central or obstructive just isn't productive for a patient, especially starting out.

Some people get central apneas from the application of pressure. I think some even call them "pressure induced centrals." Often those go away after a few weeks of therapy. If they don't, they may be worth looking into further.

After a few months of effective therapy, things should calm down and settle in. The body should get used to it and should get better at regulating its own breathing once it figures out what is going on. If it doesn't after months of therapy, and you still have a lot of centrals, it may be time to start figuring out what is going on.

Another thing to keep in mind is that a home machine may score a central apnea that naturally occurs during the wake-sleep transition or during a transition to another stage of sleep, although that central might be ignored as insignificant during a PSG. A few central apneas now and then, in that sense, happen with many perfectly healthy sleepers.
jeff
jeffnk
 
Posts: 127
Joined: Sun Nov 16, 2008 6:59 pm
Location: NYC

Postby White Beard » Fri Aug 27, 2010 2:30 am

Well KoalaMan I do know they have made allot of advances and improvement on the machines, and if you can get that kind of data that is really GREAT! I have the ResLink on my machine with the card, and the Nonnin Pulse-Ox attached to the ResLink, On the display on the machine I get the daily average AHI, AI, Average Pressure, VT, Resp Rate, MV ! When I take the card out and put it into the card reader and down load it on to my computer, I get all the info including the O2 Sat, and Pulse rate, and all the graphs, and I can look at it right down to the minute that it happened. And see it all on graphs and when seeing a AI and then seeing the O2 sat and the pulse rate and respiration rate all at the exact time the AI happened. I do wish it would have the Central or Obstructive date distinguished though! Anyway it is nice to be able to see the data that I do have, and I can make it into a report in a PDF file and send it to my Sleep Doctor, I usually down load to my computer every few weeks, I spent the extra money to get the ResLink and Pulse-ox and ResScan software, because my O2 Sats go so low and I have a concentrator and I am on 3liters of O2 with my PAP every night. So it is nice to be able to monitor it. I know for me I had a heck of a time when I first started PAP I started off on CPAP then CPAP with supplemental O2 then BiPAP with O2, finally after a year and a half and six full in lab sleep studies they finally got me on the ASV with supplemental O2 and what a difference that had made! All along the sleep center kept recommending ASV but my sleep doctor (a neurologist) refused it as he thought the techonology was to new and unproven, so he just kept increasing my pressure and changing my machine. and all that was doing was making my centrals worse! Well I kept complaining and he finally got sick and they sent me to a different doctor, and immediatelyl he set me up for a ASV titration study, and the rest is history, in May of 2008 I was given the ResMed VPAP adapt SV enhanced, and it changed my life, in two weeks the terrible bed soaking night sweats were gone, as well as the nocturia, (having to get up and go to the bathroom every hour or hour and a half!) It took about 3 months before the extreme fatigue and bone dragging tiredness started letting up and losing it grip on me and another couple of months before it was really completely gone! During those 18 miserable months on CPAP and BiPAP even though I was using the machine and mask every night all night long, I was still snoring and waking up choking and gasping for air! and I was in that mind boggling sleep apnea fog! All the those treatments with CPAP and BiPAP were doing was making my central worse! Anyway you just have to stick with it and if you do not get results then keep pressing your doctor to fix it an make it better. It is worth the time and effort! Because once you get ont the proper treatment it will change your life! Good Luck to You!.......White Beard
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 14.0, min PS 14.0, max PS 24.0, FitLife Mask
User avatar
White Beard
 
Posts: 1504
Joined: Thu Sep 20, 2007 3:27 pm
Location: Illinois
Machine: ResMed VPAP Adapt SV enhanced
Mask: Respironics Fit Life
Humidifier: yes ResMed HumidAire 2iC
Year Diagnosed: 2007

Postby KoalaMan » Fri Aug 27, 2010 10:01 am

Thanks jeff and White Beard for your replies.

I agree, jeff, from what I've read in the medical journals about complex sleep apnea it would take 9 weeks of therapy before anyone could feel confident saying that the centrals are not just transient (due to introduction of APAP) and will resolve spontaneously. I'm also aware that the machine scores events differently than a human would, and the machine has access to very limited data, so its statistics are not, strictly speaking, comparable with those generated by an in-lab sleep study.

White Beard: it sounds like you had a rough ride, but things are working well for you now. My doctor actually brought up the possibility of an ASV, but (like jeff) recommended waiting a while to see if my centrals calm down. I think I need to be a little more patient. Fortunately my symptoms are not as bad as yours were. But I understand completely what you mean by brain fog. I would very much like to "wake up" and have that sense of being underwater go away completely. I was beginning to think I was becoming "stupid" or had Alzheimer's or something. But things for me are improving some already.

Thanks to both of you!
KoalaMan
 
Posts: 32
Joined: Sat Aug 14, 2010 8:53 pm



  • Site Supporter

Return to SLEEP APNEA HELP!

Who is online

Users browsing this forum: No registered users and 0 guests

  • Site Supporter