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Permalink Reply by Rock Conner RRT on April 30, 2009 at 10:00pm

Don't jump to worrisome conclusions before you get the detailed report from your prescribing physician. One can live with episodic central apnea. We see folks in the lab who have both central and obstructive apneas. Sometimes central apneas don't show up until CPAP is applied. In fact, overtitration, which is too darned much CPAP pressure, can sometimes result in central apneas.

Treatment can involve xPAP, bilevel, ASV, & medication. IF you are diagnosed with a central apnea component, there are many available approaches. Your concern is understandable, but the overwhelming probability is that you'll be treated effectively & soon you'll be able to share your reassuring story with others in this forum.

Rock




(http://en.wikipedia.org/wiki/Sleep_apnea#Mixed_apnea_and_complex_sl...)
[edit] Mixed apnea and complex sleep apnea
Some people with sleep apnea have a combination of both types. When obstructive sleep apnea syndrome is severe and longstanding, episodes of central apnea sometimes develop. The exact mechanism of the loss of central respiratory drive during sleep in OSA is unknown, but is most commonly related to acid-base and CO2 feedback malfunctions stemming from heart failure. There is a constellation of diseases and symptoms relating to body mass, cardiovascular, respiratory, and occasionally, neurological dysfunction that have a synergistic effect in sleep-disordered breathing. The presence of central sleep apnea without an obstructive component is a common result of chronic opiate use (or abuse), due to the characteristic respiratory depression caused by large doses of narcotics.[citation needed]

Complex sleep apnea has recently been described by researchers as a novel presentation of sleep apnea. Patients with complex sleep apnea exhibit OSA, but upon application of positive airway pressure, the patient exhibits persistent central sleep apnea. This central apnea is most commonly noted while on CPAP therapy, after the obstructive component has been eliminated. This has long been seen in sleep laboratories, and has historically been managed either by CPAP or BiLevel therapy. Adaptive servo-ventilation modes of therapy have been introduced to attempt to manage this complex sleep apnea. Studies have demonstrated marginally superior performance of the adaptive servo ventilators in treating Cheyne-Stokes breathing, however, no longitudinal studies have yet been published, nor have any results been generated which suggest any differential outcomes versus standard CPAP therapy. At the AARC 2006 in Las Vegas, NV, researchers reported successful treatment of hundreds of patients on Adapt SV therapy, however these results have not been reported in peer reviewed publications as of July, 2007.

An important finding by Dernaika, et al., (Chest 2007, 132) suggests that transient central apnea produced during CPAP titration (the so called "complex sleep apnea") is "... transient and self-limited." The central apneas may in fact be secondary to sleep fragmentation during the titration process. As of July 2007, there has been no alternate convincing evidence produced that these central sleep apnea events associated with CPAP therapy for obstructive sleep apnea are of any significant pathophysiologic import.

Research is ongoing, however, at the Harvard Medical School, including adding dead space to positive airway pressure for treatment of complex sleep-disordered breathing. (Sleep Med. 2005 Mar; 6(2): 177-8PMID 15716223).

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Permalink Reply by BeeAsleep on April 30, 2009 at 10:25pm

Rock,
Thanks so much for your experience and insight. I am a newbi and I am still pretty overwhelmed with the newness of this disease. I read a summary report of my sleep study today (still going to get the full version in a few weeks from a different doctor), and you are exactly right. The central events came when the CPAP pressure was over 16 in the sleep study. My ENT said that my diagnosis was obstructive sleep apnea, even though mixed apnea was written on my report.

I am amazed how the "official" documentation can be so confusing.

As of today I going to a new doctor, my ENT, for my sleep support. She is going to switch my DME to a group she really works with and likes. I am excited to have a new doc, a new DME and now maybe I will get a machine that will help me exhale, like a biPAP. I am going to stay persistent until I get an xPAP that works for me.

Thanks so much Rock, I love reading your advice to everyone on this forum. It is so good to have a no-nonsense expert to rely on!

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Permalink Reply by sherry on May 1, 2009 at 5:44pm

Here is an interesting article I came across, as I too have complex apneas..it brought up more stuff for me to wonder about, but also answers to some basic questions.
I had a terrible time last summer when we went to Pike's Peak with elevation issues, and after that any time it was over @ 5500 feet I was affected..so more to it than just poor sleep issues.

http://www.sleepreviewmag.com/issues/articles/2007-06_03.asp

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Permalink Reply by BeeAsleep on May 1, 2009 at 8:31pm

Well, I live in Denver, 5,280 feet..... hummm. Thanks for the info I do appreciate it a lot!




sherry said:

Here is an interesting article I came across, as I too have complex apneas..it brought up more stuff for me to wonder about, but also answers to some basic questions.
I had a terrible time last summer when we went to Pike's Peak with elevation issues, and after that any time it was over @ 5500 feet I was affected..so more to it than just poor sleep issues.

http://www.sleepreviewmag.com/issues/articles/2007-06_03.asp

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