I just got a conflicting interpretation of my sleep study and need clarification.
1.  My study said that in 5.5 hours of sleep I had 27 apneas ALL of which were Central Apneas
2.  I also averaged 29 hypopneas per hour.

The pulminologist who I just saw said that even though all my apneas were Central that I also have OSA because ALL hypopneas are Obstructive.

Yet, when the person who gave be a CPAP machine read my computer read-out from the one month  was on the machine she said NOTHING about obstructive .

So, does this pulminologist know what he is talking about?  THe med tech tells my I have CSA and the Pulminologist says I have mixed?

I am confused, still tired, NOT on a machine and dont know where to turn next.

Thanks
TK

Guest,

First off let me suggest that you register, as you then are able to receive private messages.


From what I am reading, you want to know what a hypopnea is.  Here is a good link The sleep hypopnea syndrome

Quote:

Gould GA, Whyte KF, Rhind GB, Airlie MA, Catterall JR, Shapiro CM, Douglas NJ.

Department of Respiratory Medicine, City Hospital, Edinburgh, United Kingdom.

We have observed patients who clinically have the obstructive sleep apnea syndrome but have no apneas, instead having recurrent nocturnal hypoventilation. There is disagreement about the definition and significance of such sleep-related hypopneas. We have thus analyzed breathing patterns, oxygenation and sleep records of 50 consecutive patients referred with the clinical features of the sleep apnea syndrome and found to have abnormal breathing during sleep to determine: (1) the best definition of hypopnea, and (2) how frequently patients have the clinical features of the sleep apnea syndrome without recurrent apneas. Hypopnea definitions based on decreases in thoracoabdominal movement yielded hypopnea frequencies that were significantly closer to desaturation and arousal frequencies than hypopnea definitions based on flow reduction. The best hypopnea definition was that of a 50% reduction in thoracoabdominal movement lasting for 10 s. This was validated in 33 normal subjects, all of whom had fewer than 11 hypopneas/h, and fewer than 14 apneas plus hypopneas/h of sleep. Thirty-two of the 50 patients had 10 or more apneas/h, the remaining 18 having 9 to 98 hypopneas/h such that all patients had more than 16 apneas plus hypopneas/h. Patients with recurrent hypopneas were clinically indistinguishable from and had a similar frequency of 4% desaturations (zero to 104/h) and arousals (7 to 98/h) to the patients with frequent apneas. This study confirms that hypopneas are clinically important and that the "sleep apnea syndrome" may occur in the absence of recurrent apneas.

PMID: 3354998 [PubMed - indexed for MEDLINE]

Now that you are prolly more confused, here is the bigger question, regardless of Apnea, Hypopnea, UARS, etc, have you had a titration sleep study?  CSA would be treated differently than OSA, but the key is getting it treated.  Once treated, you will see the same benefits that OSA people do.  Please let us know how you progress.

Centrals apneas can also be a symptom of OSA and obstructive events can be misinterpreted as central events. That is why many people who have significant centrals during the initial study do well on regular CPAPs.  Everyone does have some central apneas each night so just having central apneas doesn't mean you have the diagnosis of Central Sleep Apnea. Its the same with OSA too- I have 1-2 obstructive apneas per hour, which is pretty normal- what's not normal is having the 60+ central apneas so I was diagnosed with CSA and not OSA or Mixed Apnea. You may very well have OSA only- you mentioned a med tech told you had CSA- they cannot diagnosis you, only a doctor can. The doctor must have interpreted the results differently, which is why they get paid the big buck and techs are underpaid (like most other front line health care workers). How are you doing with CPAP therapy? Have you noticed a difference yet? Do you know what number of apneas you had per hour at your prescribed pressure from your titration?

SleepDave had a good post recently on this subject...he's a real live sleep tech who helps us understand all apnea stuff....here it is:

sleepydave wrote:

True central apnea should be consistent regardless of position.  It may be reduced in REM, that's a personal observation for which I don't know why.  Also central apnea has a myriad of causes, but let's hold on CSA for a bit...
..except that OSA can look like CSA if the data collecting sensors aren't quite picking up everything.  We try CPAP in these cases, and if it works, we go AHA! it's really OSA.  True CSA will not respond to CPAP, for that matter probably not even BiPAP, and I invite debate here.  CSA is complex and cannot be dismissed off-handedly by "Let's get out the cpap."
So anyway, you've got some response in the CPAP titration, so/and there appears to be some OSA component.  Now, you can also generate CSA with aggressive CPAP titration

Here's the link to the entire thread: http://www.apneasupport.org/viewtopic.php?t=472

Since we would hope (though sadly not alway so) that the doctor is the expert and the one to trust, I would call him/her and simply explain to them what you posted and ask for clarification.  OSA requires quite a bit of self-advocacy.  Though they may be correct, generally sleep techs are not suppose to be interpeting and relaying their diagnosis to the patient.  They work for the doctor.

Vicki

Thanks folks.
1.  I will register in the near future so I can recieve PM's etc...
2.  I was on the CPAP for one month...and got worse...in my opinion.  The med tech took a card out of the CPAP machine after one month, put it in a machine and got a computer readout.  It is at that point she said I was having a lot of Apneas and especially hypopneas "all over the place".
To her credit she did say she could not understand it. She gave me a bi-pap machine which I tried and that was even worse.
3.  I have never had a titration study.  The last doctor I saw said I should have one done to see if there is any help from any machine etc....
4.  Since I am a thin, 5'7" athletic, runner who is NOT overweight, I dont have tonsils, and I dont have adnoids or a large tongue I am confused as to how I could have any obstructive sleep apnea.  The last doctor I saw said he couldnt tell me why...he just said..."All hypopneas are Obstructive...so you MUST have OSA".  He could not explain his reasoning, so this is why I am confused....plus, the CPAP didnt seem to make me feel better at all...just worse.
5.  At this point I am going to sign up for a titration sleep study because I think that will at the least be another bit of information I could use.
6.  My ENT who I originally saw is someone who I dont have a lot of trust in.  Remember, He gave me a script for a sleep study, I had it done...and at my next appointment with him
a.  He never went over the sleep study...he just said.."You have acute sleep apnea, lets get you on a machine"
b.  He did not ask for a titration study, he just asked me how I felt after a few weeks...and said well give it some more time etc...
c.  He never mentioned CSA v.s. OSA

I feel that you all here at the board have more knowledge than the "experts" I am seeing...so this makes things VERY stressfull and frustrating.

7.  I HAVE noticed an improvement in my mood, depression, irritability, and fatigue since I started using a mouthguard for TMJ and started taking melatonin nightly.
I feel more refreshed in the morning, have more energy for sure.  Also, my wife says Im sleeping soundly and not snoring at all anymore.  I realize this does not mean I am not having apneas etc... but I have noticed an improvement in symptoms.

Thanks for the input folks
TK

TK,
I just wanted to comment on the mouthguard for TMJ.  I have jaw problems too and for a while was using an occlusal splint to treat it.  I noticed that the splint made my lower jaw come forward some, so you might actually be deriving some benefit for your apnea from it since it may be making the airway a little larger.  According to the facial pain clinic that I use(which is part of a larger medical center), the two conditions happen together frequently enough that they don't consider it unusual.  Personally, I would bet that a TMJ device used in conjunction with a CPAP would be extremely effective, but that is just my personal guess, based on my own TMJ experiences.  I stopped wearing my splint ages ago, but I have a fitting for a new one at the end of September, so I will ask all the questions about TMJ and OSA that I can think of then.  I guess I'll find out first hand how effective my theory is in the next month or so since I will have a splint and be on CPAP as well.  

Hi TK!
Was your initial study an in-home or in-lab study?  Can you get the complete report from your doctor? It would be good to know as much detail as possible, including oxygen desaturations and arousals.  If you had an abbreviated study and some channels were not used, you might have a whole different issue (like PLMs, for instance) that an abbreviated study may not pick up.  Sounds like an Auto-titrating unit was used, but strange there were so many respiratory events that the machine did not correct.  Unless they were all centrals, perhaps from a non-respiratory cause (I know "central" sounds bad, but there are plenty of centrals that are totally harmless, and yours almost certainly are.  Which is why we need to see more of the report).  Centrals can be can be caused by something as simple as a sigh, or an arousal.  Any details on the CPAP machine, including settings may be helplful, but I don't think that was it.
Going back to your original question, hypopneas can be either obstructive, central or mixed.  Central breathing reductions in the 50-80% range aren't real common to begin with, and since you need an arousal and/or a desaturation to occur after it to be classified as a hypopnea, you generally rarely see them.  When you do see them, they're in a particular patient, and not a widespread phenomena.  And mixed hypopneas?  Practically speaking, they almost can't happen.  So that statement that "all hypopneas are obstructive" is incorrect, but I suppose you can get away with it 95% of the time.
Based on the information so far, though, I don't think you can come to any conclusions whatsoever, so see what else you can dig up. Stay in touch.
sleepydave



Last edited by sleepydave on Sat Sep 03, 2005 7:44 pm; edited 1 time in total

Anonymous wrote:

4.  Since I am a thin, 5'7" athletic, runner who is NOT overweight, I dont have tonsils, and I dont have adnoids or a large tongue I am confused as to how I could have any obstructive sleep apnea.  

For the same reason I don't have OSA, yet I am overweight, not athletic, large neck, and such an extremely small throat space that my sleep specialist said any doctor would bet on me having OSA based on that alone. The stereotype that only fat, overweight, middle aged men are the only people who can have OSA is outdated. Of course if a doctor still believes it, it will be true in his practice since he would never send a skinny, young female for a sleep study since 'there's no possiblity of her having OSA' in his mind.  Yes, weight, age, physical fittness can affect OSA but they are not the only factors. Children can get OSA and you just have look at the number of women posting her to realize a lot of women get it too.

Anonymous wrote:

c.  He never mentioned CSA v.s. OSA

Most doctors don't make a distiction- when they say 'apnea' they mean obstructive and only add in central or obstructive if centrals are an issue from what I've seen. Central apneas were not mentioned to me until I got the results of my sleep study- I didn't even know the difference until my doctor told and I read everything I could find on-line. When my mom went through her sleep studies and was diagnosed with OSA & PLMD the only time her doctor mentioned CSA was to tell her that her apnea a different type then mine, otherwise the doctor probably wouldn't have even mentioned central apneas (she sees the same doc I do). From my point of view, its a hassle because everyone- including most doctor- think there is only one kind of apnea- obstructive, so I find myself having to explain the difference.  When I had surgery recently I had to keep telling all the nurses & doctors I had CSA, not OSA...even the anesthesiologist who wrote joted down important information from my computerized chart had written OSA. I wish more doctors knew about CSA- it would make my life easier...either that or give it a different enough name...CSA looks to close to OSA even when typed.

Anonymous wrote:

7.  I HAVE noticed an improvement in my mood, depression, irritability, and fatigue since I started using a mouthguard for TMJ and started taking melatonin nightly.
I feel more refreshed in the morning, have more energy for sure.  Also, my wife says Im sleeping soundly and not snoring at all anymore.  I realize this does not mean I am not having apneas etc... but I have noticed an improvement in symptoms.

Does the splint position your jaw forward-even slightly? Even if it doesn't it probably is making you hold your tongue differently enough that it could keep it from blocking your airware as much. Since you have to wear a bite splint already you may be a good canidate for an oral appliance to help reduce your OSA.

Back to your original post:

Quote:

1. My study said that in 5.5 hours of sleep I had 27 apneas ALL of which were Central Apneas
2. I also averaged 29 hypopneas per hour.

If I'm reading it correctly you had less then 5 centrals apneas per hour and 29 hyponeas, right? Do you have a copy of the results? Less then 5 apneas per hour is considered "normal", add in what sleepydave told us about hypopneas being obstructive 95% of the time and that obstructive apneas can be misinterpreted as centrals, I would say the odd are in your favor for OSA over CSA at this point. I agree that getting your titration study is the next logical step to help you figure out what will work the best. In the mean time, are you using a CPAP or BiPAP?

Quote:

Yet, when the person who gave be a CPAP machine read my computer read-out from the one month was on the machine she said NOTHING about obstructive .

While CPAPs- including autoPAPs- are getting smarter, they cannot tell if you are having a central apnea...all they can do is make an educated guess.

sleepydave wrote:

...strange there were so many respiratory events that the machine did not correct....

What about if for some reason the auto wasn't set wide open? Wouldn't it be possible if say it was set from 5-15 that he could have had apneas that needed an higher pressure?

Quote:

What about if for some reason the auto wasn't set wide open? Wouldn't it be possible if say it was set from 5-15 that he could have had apneas that needed an higher pressure?

Quote:

Any details on the CPAP machine, including settings may be helplful, but I don't think that was it.

Sure could have had a low range....could even been set at a fixed pressure of say like, 5 cmH2O.  Right now I'd like to give them the benefit of the doubt, though.  That the tech was stumped sorta suggests the common causes were ruled out, and we should be able to see that on the CPAP report.

TJ wrote:

I HAVE noticed an improvement in my mood, depression, irritability, and fatigue since I started using a mouthguard for TMJ...

If that alone is helping, how bad could the SBD be, that a straight 5 wouldn't substantially help anyway?

TJ wrote:

...and started taking melatonin nightly

That might prove to be a helpful little tidbit.  The sleep study should give us information to know if we should go down that road.  Right now, too many variables, too little information.
Check back.
sleepydave



Last edited by sleepydave on Wed Aug 31, 2005 5:24 pm; edited 1 time in total

Just a quick clarification.

1.  I bought a rubber Mouthguard, which is in the dental section of the grocery store...cost $21 and you heat it up mold it to your teeth and wear it when you sleep.

The main reason I bought it was because I grind my teeth at night and have chipped a bunch.
It only "attaches" to the roof of my mouth not the tongue or bottom...of course maybe that changes when I sleep.

2.  I just got a book from the library on Sleep Apnea.  I am at work and dont remember the title.  Anyway, there were TWO case studies that showed a link between depression/anxiety/stress and sleep apnea.

Both people in the study had sleep apnea, both got treatment for the depression.  THey changed their lifestyle/thinking etc... and BOTH had NO sleep apnea.
I am in this category of depression and stress and bad sleep habits etc....
Since I have made some serious attitude and lifestyle changes I have noticed (and my wife) a HUGE improvement in my sleep and symptoms.
Agian, I am NOT discounting a purely physical issue but...these studies show a direct link between stress and apnea.
I will get you all the reference tonight or tomorrow.
tk