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Central Sleep Apnea vs. Obstructive Sleep Apnea
My friend has been diagosed with OSA (Obstructive Sleep Apnea), but upon looking at his latest titration study, it indicates that of his 21 events, 19 were central apneas, and only 2 were obstructive apneas. As an additional data point, almost all the events were happening in Non-REM sleep, and lasted, on average, about 20 seconds... a long time to not breathe.
My question is this: if his apneas are predominantly central and not obstructive, shouldn't he be getting a diagnosis of central sleep apnea, and not OSA. And related to that point, instead of using the straight CPAP he's currently on (pressure of 14), shouldn't he be on ASV?
My question is this: if his apneas are predominantly central and not obstructive, shouldn't he be getting a diagnosis of central sleep apnea, and not OSA. And related to that point, instead of using the straight CPAP he's currently on (pressure of 14), shouldn't he be on ASV?
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Replies to This Discussion
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Permalink Reply by RichM on
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I am on a ST due to my OSA and CSA's. I had started out on a OSA since 1998 and then after my car accident 2 years ago. I went to get another titration study this past December and found that I was having CSA's also. Some of it is due to my head injury and some of it is caused by Medication (pain meds mostly). Does you friend take pain meds ? if so he most likely will need the back pressure due to his/her mind is forgetting to breath. What type of machine does he have now?
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Permalink Reply by Mike on
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No, my friend isn't on pain meds that i know of. right now, he's using a resmed auto-adjusting cpap (with EPR -- expiratory pressure relief) at 14 pressure setting.
RichM said:I am on a ST due to my OSA and CSA's. I had started out on a OSA since 1998 and then after my car accident 2 years ago. I went to get another titration study this past December and found that I was having CSA's also. Some of it is due to my head injury and some of it is caused by Medication (pain meds mostly). Does you friend take pain meds ? if so he most likely will need the back pressure due to his/her mind is forgetting to breath. What type of machine does he have now?
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Permalink Reply by RockRpsgt on
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It is my opinion that he should be on the ASV, or at least some sort of BiPAP treatment. I can't say for sure without reading the report.
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I'm posting the applicable sections of his titration report below:
Rock Hinkle said:It is my opinion that he should be on the ASV, or at least some sort of BiPAP treatment. I can't say for sure without reading the report.
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The pap treatment, according the study, seems to have cleared up the apnea. As long as your friend can handle the treatment and it is clearing up any sleep maintenence or daytime fatigue issues I would run with it for a while. I know at our lab Sometimes because of insurance reasons we have to prove that the cpap does not work before we can switch to bipap or the asv. If your friend is having trouble I would definately talk to a sleep Dr.
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Mike what I don't understand is why when the events stopped at a pressure of 10 they raised it anyway. at my lab the rules state that a pt has to have an average of above 5 apneas per hour to raise them. So I would have stopped at 10cmwp. A techs goal during titration is to get the average as much under 5 as we can. The report clearly shows no apneas at 10. However I am not a Dr. nor do i know anything about this pt. please keep that in mind.
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understood, and we certainly will also consult with a sleep doc. but to your point, the weird thing is that when they increased the pressure beyond 10, looks like it screwed him up more and he had more events. he totally zeroed out at 10, and then got worse above 10. hmmm....
Rock Hinkle said:Mike what I don't understand is why when the events stopped at a pressure of 10 they raised it anyway. at my lab the rules state that a pt has to have an average of above 5 apneas per hour to raise them. So I would have stopped at 10cmwp. A techs goal during titration is to get the average as much under 5 as we can. The report clearly shows no apneas at 10. However I am not a Dr. nor do i know anything about this pt. please keep that in mind.
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I am assuming that this is 2 different studies, and not a split study, right?
Mike said:understood, and we certainly will also consult with a sleep doc. but to your point, the weird thing is that when they increased the pressure beyond 10, looks like it screwed him up more and he had more events. he totally zeroed out at 10, and then got worse above 10. hmmm....
Rock Hinkle said:Mike what I don't understand is why when the events stopped at a pressure of 10 they raised it anyway. at my lab the rules state that a pt has to have an average of above 5 apneas per hour to raise them. So I would have stopped at 10cmwp. A techs goal during titration is to get the average as much under 5 as we can. The report clearly shows no apneas at 10. However I am not a Dr. nor do i know anything about this pt. please keep that in mind.
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it was a single study. here's a response I got by email from a sleep lab tech friend of mine:
"from my observation the pressure is high. The prescription for cpap is probably right though due to the insurance requirements. I feel for my pts when in the first study I can see that it is going to be a long process. Even if your friend needs Bipap, he will have to go through the ordeal of failing cpap. It is kind of a contradiction that these rules are set up to save the insurance companies money, when in the case of this pt, it will ultimately cost them 3-4x more. Some advice that I'll give you is to have pts before their first study:
1-Find out whether or not a clinic is accredited (especially if it is an idependent diagnostic testing facilty "IDTF")
An IDTF does not have to play by the same rules as a hospital facility. Allthough thay are normally nicer and set up with more emphasis on pt comfort. Whereas a hospital facility will put the emphasis on the study.
2-Make sure that the techs are certified (RPSGT). This is very important especially for medicare/medicaid study integrity. In a IDTF a RPSGT has to perform the entire study for medicare/medicaid pts. In a hospital setting RPSGT can supervise uncertified techs.
3-If the lab employs uncertified techs, does an RPSGT oversee them (this is the law). Also how are the uncerts being evaluated?
1-Have they finished the 14 online modules or taken the ASTEP program?
2-Does your lab have quarterly competency evaluations for them to make sure they are on track?
4-RRT vs RPSGT- A RPSGT has to go through extensive training to be able to evaluate sleep. An RRT goes through extensive training to evaluate breathing and lung function. I know that there are quite a few RRTs that know what they are doing, but they are not required to go through any of the training or certifications that we do. Sleep is not a lung function, Apnea is not a lung problem. It is a sleep problem. Ideally I would want my testing facility to employ both, but I would want a sleep tech to do my study.
5-Is the Dr. Sleep certified? Demand to see him before the studies for a well educated discussion on study procedures, and after the completion of the study process for an explanation of the studies, and to go over the different treatment options. Remember the pt pays for the insurance, and can always call them to deny payment until they are satisfied with the treatment. Insurance companies will gladly hold onto the money a little longer.
I hope this helps. I think that if every pt does a little homework in the beginning it will alleviate some of the problems."
Rock Hinkle said:I am assuming that this is 2 different studies, and not a split study, right?
Mike said:understood, and we certainly will also consult with a sleep doc. but to your point, the weird thing is that when they increased the pressure beyond 10, looks like it screwed him up more and he had more events. he totally zeroed out at 10, and then got worse above 10. hmmm....
Rock Hinkle said:Mike what I don't understand is why when the events stopped at a pressure of 10 they raised it anyway. at my lab the rules state that a pt has to have an average of above 5 apneas per hour to raise them. So I would have stopped at 10cmwp. A techs goal during titration is to get the average as much under 5 as we can. The report clearly shows no apneas at 10. However I am not a Dr. nor do i know anything about this pt. please keep that in mind.
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based on all this, sounds like my friend is being dragged through some hoops for insurance reasons, but that his final destination is ASV for central sleep apnea...
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Permalink Reply by Butch Hernandez on
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It looks like he was titrated pretty agressively. Given the posted report, I think OSA is an accurate diagnosis. If anything, his CSA events were predominant at lower pressures suggesting Complex Sleep Apnea..however, the centrals did not persist as pressures were increased. His AHI at 14cmH2O, was almost 0 and that's well within acceptable parameters for an effective titration. For those reasons, I'd say OSA is the correct diagnosis. At face value, it does seem like CSA would be more likely, but the clinical data doesn't support that diagnosis.
On a side note, the tech that ran the study did a great job treating. Most of us rely on training and instinct. After all, titrating is more of an art than a science ;)
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can Central Sleep Apnea or Complex Sleep Apnea be effectively treated with straight CPAP?
Butch Hernandez said:It looks like he was titrated pretty agressively. Given the posted report, I think OSA is an accurate diagnosis. If anything, his CSA events were predominant at lower pressures suggesting Complex Sleep Apnea..however, the centrals did not persist as pressures were increased. His AHI at 14cmH2O, was almost 0 and that's well within acceptable parameters for an effective titration. For those reasons, I'd say OSA is the correct diagnosis. At face value, it does seem like CSA would be more likely, but the clinical data doesn't support that diagnosis.
On a side note, the tech that ran the study did a great job treating. Most of us rely on training and instinct. After all, titrating is more of an art than a science ;)
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