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Central Apnea Info, PLEASE HELP!!
Hi Everyone,
I have obstructive and central apnea, I notice there is a lot of information about obstructive apnea, but I can't find much info on cetral apnea. I am a veteran so I use the va hospital and the doctor there don't seem to know what is causing my central apnea. I had test done on my heart , so it isn't heart failure. I am really concern because what I have read on line central apnea is not common and it is usually due to a serious illness.
PLEASE HELP!!
I have obstructive and central apnea, I notice there is a lot of information about obstructive apnea, but I can't find much info on cetral apnea. I am a veteran so I use the va hospital and the doctor there don't seem to know what is causing my central apnea. I had test done on my heart , so it isn't heart failure. I am really concern because what I have read on line central apnea is not common and it is usually due to a serious illness.
PLEASE HELP!!
Views: 1451
Replies to This Discussion
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Permalink Reply by Sandra Ford on
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Thanks RD
RD said:Hi Sandra,
From what I understand, central apneas occur when we don't breath at all. As explained to me by my sleep specialist, with OSA and hypopneas the chest and stomach show movement as if to try and breath normally. With the central apneas the signal to breath from the brain doesn't happen and the chest and stomach don't move to facilitate the breathe. From some of the articles I've read on it, some think that it's our survival mechanism that finally triggers the need for air when the CO2 concentration gets too high in our lungs.
In my study, I had 154 episodes with 1osa and the rest split somewhat evenly between hypopneas and central apneas. So, I do understand what your thinking. I was asked if I had any concussions or other head trauma that I could recall. I have no serious illnesses to worry about. More than likely NEITHER DO YOU! Some neuro connection just isn't being made all the time. While centrals are the result of a neuro disconnect somewhere in the brain, no one from the articles can pinpoint a single cause for these events. In my world, the treatment of choice for both my centrals and hypopneas is use of the CPAP machine. The VA tends to view this the same way basically. In fact, some of the better articles and research notes I've read online come from the VA.
Having said that, go to www.va.gov and search under sleep apnea and read for yourself some of the articles before going to other sites. The VA has a big interest in this and will get bigger as more war veterans who have experienced some type of head trauma get cycled through the system. Some are even getting disability ratings for SA that was is considered duty related. Check again with your VA rep or DAV advocate.
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Permalink Reply by Vicki E Jones on
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Rock -
But what would cause the high oxygen levels in the lungs???
Vicki
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Rock Hinkle said:you seem to know way more about ASV than I do. that is usually the case with ASV/AVAP patients. Leslie is a tech in Colorado. I have read very little of altitude causing CSA. I can see how it could happen though. It is my understanding that CSA is caused by a lack of signal from the brain to breathe. The most obvious reason for this would be high 02 levels in the lungs which would cause a delay to the hypercapnic drive.
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Rock -
I am in the far southeast suburbs, about 7 miles west of the Munster, Indiana border.
Vicki
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Rock Hinkle said:What part of Chicago are you from? My wife is from the Antioch/Lake Villa area. I love it up there. if it were not so expensive I would move. I like the lakes.
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Permalink Reply by RockRpsgt on
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More importantly what causes the low co2. We breath to get rid of Co2. The o2 intake is actually a byproduct of the hypercapnic drive. When our co2 levels drop the brain does not send the signal to breathe. There are a multitude of health disorders that can cause this including neuromuscular disease, Brain stem or head injury, Neuromuscular insufficiency (ALS Lou Gehrigs Disease, Myotinic Dystrophy, Wernig Hoffman's Disease, and any other "anterior horn cell disease"), Congestive heart failure, high altitudes and COPD. PAP pressures set to high can actually flush the co2 out of your lungs. this why so many techs are against self titration without a physician's consent.
http://www.journalsleep.org/Articles/290911.pdf
http://www.ncbi.nlm.nih.gov/sites/entrezVicki E Jones said:http://www.journalsleep.org/Articles/290911.pdf 3A43790&x=1#2549090Comment43789">
Rock -
But what would cause the high oxygen levels in the lungs???
Vicki
*********
Rock Hinkle said:you seem to know way more about ASV than I do. that is usually the case with ASV/AVAP patients. Leslie is a tech in Colorado. I have read very little of altitude causing CSA. I can see how it could happen though. It is my understanding that CSA is caused by a lack of signal from the brain to breathe. The most obvious reason for this would be high 02 levels in the lungs which would cause a delay to the hypercapnic drive.
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http://www.chestjournal.org/content/early/2007/05/02/chest.06-2562....
The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies
Tarek Dernaika, MDTarek-Dernaika@ouhsc.edu1, Maroun Tawk, MD, FCCP1, Shoab Nazir, MD2, Walid Younis, MD1, and Gary T. Kinasewitz, MD, FCCP1
+ Author Affiliations
1University of Oklahoma Health Sciences Center, Oklahoma City, OK
2University of Arkansas for Medical Sciences, Little Rock, AR
Abstract
AbstractObjective
To determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy.
Design
Cross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG).
Patients and methods
Forty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients.
Results
Demographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study.
Conclusions
CSA events occurring during CPAP titration are transient and self limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP related CSA.
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Interesting study, Rock.
I had more CSA events before I went on CPAP and oral appliance, but still had 21 events per hour during my April 2009 study (CSA events) with CPAP and oral appliance (overnight sleep study). The VPAP titration, when the correct titration was reached, corrected the CSA events 100%, and also (with oral appliance) the OSA events.
Different people need different approaches. I have no heart failure - have had stress test with nuclear scan, echocardiogram, etc. Do have mitral valve prolapse, which can cause or contribute to apneas, but I'm not sure
if CSAs or OSAs. Have Fibromyalgia. Don't think there is MS (Multiple Sclerosis), but I've had some odd symptoms and need to check this out. Several cervical spine conditions that could interrupt a signal to breathe - stenosis, badly
bulging disks, etc.
Haven't had my lungs checked in recent years, and should rule out lung conditions, but no cough.
Initially, though, my OSAs and Central apneas were thought due to the retrognathic lower jaw.
If you know of someone who does mandibular advancement surgery, in greater Chicago area,
please provide the name and phone number. The surgery would help both day and nighttime
breathing. I have to drop my jaw slightly and bring it forward to bring well, day-time, too.
Vicki
*******
Rock Hinkle said:http://www.chestjournal.org/content/early/2007/05/02/chest.06-2562....
The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies
Tarek Dernaika, MDTarek-Dernaika@ouhsc.edu1, Maroun Tawk, MD, FCCP1, Shoab Nazir, MD2, Walid Younis, MD1, and Gary T. Kinasewitz, MD, FCCP1
+ Author Affiliations
1University of Oklahoma Health Sciences Center, Oklahoma City, OK
2University of Arkansas for Medical Sciences, Little Rock, AR
Abstract
AbstractObjective
To determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy.
Design
Cross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG).
Patients and methods
Forty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients.
Results
Demographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study.
Conclusions
CSA events occurring during CPAP titration are transient and self limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP related CSA.
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I am not very familiar with the docs or labs in Chicago. Your sleep doc or PCP may be able to recommend one. Dr. Park or Dr. Mack may know someone. Try PMing one of them.
Vicki E Jones said:Interesting study, Rock.
I had more CSA events before I went on CPAP and oral appliance, but still had 21 events per hour during my April 2009 study (CSA events) with CPAP and oral appliance (overnight sleep study). The VPAP titration, when the correct titration was reached, corrected the CSA events 100%, and also (with oral appliance) the OSA events.
Different people need different approaches. I have no heart failure - have had stress test with nuclear scan, echocardiogram, etc. Do have mitral valve prolapse, which can cause or contribute to apneas, but I'm not sure
if CSAs or OSAs. Have Fibromyalgia. Don't think there is MS (Multiple Sclerosis), but I've had some odd symptoms and need to check this out. Several cervical spine conditions that could interrupt a signal to breathe - stenosis, badly
bulging disks, etc.
Haven't had my lungs checked in recent years, and should rule out lung conditions, but no cough.
Initially, though, my OSAs and Central apneas were thought due to the retrognathic lower jaw.
If you know of someone who does mandibular advancement surgery, in greater Chicago area,
please provide the name and phone number. The surgery would help both day and nighttime
breathing. I have to drop my jaw slightly and bring it forward to bring well, day-time, too.
Vicki
*******
Rock Hinkle said:http://www.chestjournal.org/content/early/2007/05/02/chest.06-2562....
The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies
Tarek Dernaika, MDTarek-Dernaika@ouhsc.edu1, Maroun Tawk, MD, FCCP1, Shoab Nazir, MD2, Walid Younis, MD1, and Gary T. Kinasewitz, MD, FCCP1
+ Author Affiliations
1University of Oklahoma Health Sciences Center, Oklahoma City, OK
2University of Arkansas for Medical Sciences, Little Rock, AR
Abstract
AbstractObjective
To determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy.
Design
Cross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG).
Patients and methods
Forty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients.
Results
Demographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study.
Conclusions
CSA events occurring during CPAP titration are transient and self limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP related CSA.
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Permalink Reply by Leslie Scott on
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Not usually. We do have patients that do need the oxygen, but that is generally an underlying respiratory issue. Most of the time, we tell the patient up front that they will most likely only need it short term.
Rock Hinkle said:Do you have any problems with your patients developing a psychological addiction to the o2?
Leslie Scott said:
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I understand that not everyone is overweight. But weight can make a difference. That is all I am saying. Doing a study as I type right now on someone who is NOT overweight, yet I had to put her on cpap.
Vicki E Jones said:We aren't all overweight. I have both obstructive and central sleep apneas and I am over 5'7" (at age 62, yet) and weigh 142 lbs.
Vicki in Illniois
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Leslie Scott said:I always tell patients that even a 10% weight loss can inprove OSA and if symptoms start coming back, it's time to come back for a retitration. There is a fine line between enough pressure to treat OSA and causing central apneas.
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The first thing I treat is Obstructive apneas. We treat the OSA and then we deal with the CA. If a patient is having primary central apneas, then we use oxygen to treat the centrals. If they are having both, we use cpap to treat the obstructive and then we add oxygen inline to treat the centrals.
I use biPap for the higher levels of pressure or for when a patient is having a really hard time tolerating cpap. Here at our lab, we don't use it for that. That is not saying that it is not correct, but that apparently there are different ways of dealing with things depending on what part of the country you are in.
At the same time, they are constantly coming out with new and improved things. It doesn't always trickel down to the labs as quickly as it comes out. I have been a Respiratory Therapist for a very long time, and I know that they would have new equipment come out all the time and it would take forever to get it into the staff at the hospitals.
Again, I'm not saying that what we do it 100% correct or what someone else does is wrong. What I am saying is what we do here. We also have altitude to contend with, so that might make things different than what a lab at sea level would do.
Hope that helps a little.
Leslie in CO
Vicki E Jones said:I hate to ask this, but if CPAP causes Central sleep apnea and the correct treatment is oxygen and not CPAP, then why were the ResMed VPAP Adapt SV machine and the Respironics Auto BiPap SV machines developed, and why are titrations being done with them and machines rented, sold, and in use/prescribed/recommended by top institutions?
Also, if a person needs CPAP for OSA and oxygen for CSA (Central Sleep Apnea), but one requires oxygen and the other requires CPAP, what is the person who has mixed or complex apneas (has both, like me) supposed to do???
The SV are automated servo-ventilator BiPap machines, I think, and are for Central, but correct Obstructive, and can run in either SV BiPap or SV mode.
????I am confused. ???
Vicki in Ilinois
Rock Hinkle said:Do you have any problems with your patients developing a psychological addiction to the o2?
Leslie Scott said:There is a fine line between enough pressure to treat OSA and causing central apneas.
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Thanks for looking this up Rock. I was just headed there for the same thing. And glad to find out that I was right about the altitude... as we are at 6000 feet, we fall into the category they listed (my house is at 7K and we have a lab up the pass at 9K feet)
I love all this conversation. It is making me look stuff up to make sure I am right. I am sitting for my PSG registry in Nov/Dec so the studying will help me get ready as well :) (I'm already registered for respiratory) I know that when I started as a respiratory therapist, I was in Phoenix at sea level. I swear I had to learn everything all over again when I moved to altitude!!!
Les in CO
Rock Hinkle said:We are all right.
http://www.ncbi.nlm.nih.gov/pubmed/18363194?ordinalpos=4&itool=...
Central sleep apnea (CSA) is characterized by a lack of drive to inspire for at least 10 . high altitude-induced periodic breathing (above 4000 m), -ventilation.
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I asked because we get quite a few patients that come in on o2. They panic when I explain to them that I will have to start the study without.
Leslie Scott said:Not usually. We do have patients that do need the oxygen, but that is generally an underlying respiratory issue. Most of the time, we tell the patient up front that they will most likely only need it short term.
Rock Hinkle said:Do you have any problems with your patients developing a psychological addiction to the o2?
Leslie Scott said:
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