diaphragmatic dysfunction

[vgrando]

Does anyone know how diaphragmatic dysfunction affects sleep apnea? I read that C5 is the nerve root that affects the diagram.

I am concerned because I have long-standing moderate to severe stenosis of C3 to C5 and a moderate sliding hiatial hernia that has been causing issues, including excessive belching and hiccups.

I found this informative article.
Ali, R. H., Farouk, M. M., & Moussa, S. G. (2021). Cervical spondylosis as a possible hidden reason beyond delayed phrenic nerve distal motor latency. Egyptian Rheumatology and Rehabilitation, 48(1), 1-4. https://doi.org/10.1186/s43166-020-00051-0

[Jay51]

I did some research on this after my sleep study showed very large amounts of central apneas.   The phrenic nerve is the motor nerve to the diaphragm.  Most of the time, the problem is centered in the brain itself.  The phrenic nerve is just fine and normal, but the abnormal signal is originated in the brain itself.  
The phrenic nerve can be damaged by trauma, etc.  It that case, the brain sends the correct signal to the diaphragm to breathe, but the signal gets messed up along the phrenic nerve.  (By the way, I have C3, C4, and C5 cervical disk degeneration - although my motor neuron studies show everything is normal.  I have also had some concussions playing football and have been involved in 2 major automobile accidents - possibly trauma to the nerve itself though or my brain).  The diaphragm itself can be damaged also - the brain is working correctly (correct signal) and the phrenic nerve sends the correct signal to the diaphragm, but the diaphragm itself malfunctions.  
You might possibly want to look into phrenic nerve testing in the future if you choose to do so (Neurologist, etc.). 
I apologize in that I stated that you need supplemental oxygen if you are desaturating during the day.  It seems like a no-brainer to me, but your former Dr. had some reason for taking you off of supplemental oxygen.  But you said he stopped talking to you and never gave you an explanation as to why he did that.  I have worked in several hospitals and for many Dr.'s in my former career (I am not a Dr. though and don't give medical advice).  You must have also worked with many Dr.s being a retired nurse.  
Do you have any problems with aerophagia (swallowing air) at night using your PAP machine?  Wondering if the sliding hiatal hernia is causing any aerophagia problems?

[vgrando]

Thank you! Your comments are always appreciated!

I am reading as much as possible for tomorrow's new MD visit.

The article on nocturnal hypoventilation answered a lot of my questions. 

My low 02 results from my hypoventilation and low tidal volumes. And all of the pulmonary function tests I have taken are when I am awake and shed no light on my sleep hypoventilation. Although, we needed to rule out pulmonary disease. 

So, I am left with chest wall structural problems affecting my nightly desaturation etc.  And I just read that chest wall structural problems leads to atelectasis, which I have and is well documented via CT scans for over four years. 

Severe C5 nerve root damage is part of the picture. It started 50 years ago!  I have had repeated muscle spasms and pain.  I know I have C5 root damage because I still have lingering numbness in my right thumb and right-hand weakness from an episode of severe neck pain. Many MIRs document this.  I will ask to have a nerve test done.

All of what I am posting is well documented in my medical records plus blood word showing elevated red cells, hematocrit, and C02.

I am the only one looking for an answer and putting it all together.