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How Does ResMed APAP distinguish OSA vs. CSA?
#1
How Does ResMed APAP distinguish OSA vs. CSA?
Hello all, first post here, please bear with me.

I have just started using a PAP device for the first time, specifically a ResMed AirSense 10, for the previous two nights.

The only previous sleep test I'd taken that could detect apneas (as well as distinguish between obstructive and central apneas) was a Snap Diagnostics at-home test taken ~2 months ago, which included a chest belt to monitor abdominal motion. It showed mild-to-moderate OSA, with apneas *overwhelmingly* dominated by obstructive rather than central (25 OSA events to 1 CSA event in a 6 hr period).

Using the AirSense 10, I was in APAP mode with max/min pressures set to 9 and 4 cmH2O, respectively (first night), and 8 and 4 cmH2O, respectively (second night). EPR was set to reduce expiratory pressure by 1 cmH2O.

Both the AirSense 10-generated sleep reports and the OSCAR outputs indicated that OSA's had been eliminated *completely* on both nights, but also reported a substantial number of CSA's (21 first night, 12 second night). While the overall AHI for both nights was certainly acceptable (3.91 and 2.46, resp.), I was surprised to see such a large number of CSA's, considering that the Snap test detected only 1 in an entire night.

So, my first question is: Could the use of this APAP device have *immediately* induced so-called Treatment-Emergent CSA's?

And my second question is: How can this device distinguish between OSA's and CSA's in any case? That is, it would seem that the only information actually available on the machine end is pressure and flow rate vs. time... I can see how that would allow detection of a cessation in breathing, but how could it detect an unsuccessful attempt to breathe, without any information about abdominal motion?

Thanks so much for any info!
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#2
RE: How Does ResMed APAP distinguish OSA vs. CSA?
from the wiki https://www.apneaboard.com/wiki/index.ph...pnea_(CSA)

Quote:Central Apnea (CA) is a term used by Resmed to flag an apnea event where an open airway is detected by the Forced Oscillation Technique (FOT), which is a 1-cm pressure oscillation at 4-times per second.

the way i understand it is it sends some air, if it doesn't encounter resistance and you aren't breathing after your last exhalation it's pretty clear you are having a CA.

yes it happens most often at the beginning of therapy and should lessen over time as you get used to therapy.
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#3
RE: How Does ResMed APAP distinguish OSA vs. CSA?
To help you we really need data from OSCAR. It is totally free to download and use from the top of the page.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: How Does ResMed APAP distinguish OSA vs. CSA?
Narcil, thanks for your reply. I found a ResMed link that discusses the FOT in a little more detail (I'm not including the link here, I gather that links to commercial/vendor sites are frowned upon). It's a clever idea indeed.

I certainly hope the CSA's fade out, don't want to replace one problem with another!
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#5
RE: How Does ResMed APAP distinguish OSA vs. CSA?
@stacyburke,

I'm already using OSCAR, which I must say is a very impressive tool... I don't even use the Sleep Report generated by the ResMed unit itself.

I didn't bother with posting any OSCAR output, since I was really only referencing raw CSA count.

I'll review the OSCAR Chart Organization Wiki page to get more familiar with the plot/data-posting protocols.
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#6
RE: How Does ResMed APAP distinguish OSA vs. CSA?
Interesting! I zoomed in on one of my (few) CAs, and you can actually see the small pressure oscillation in the 'mask pressure' data.

Perhaps Oscar should be changed to refer to them as Central Apnea events rather than Clear Airway events, since central is a more medically correct and widely used term, and clear airway is a term that only Philips uses. It would be possible to change the notation depending on whether a Philips or ResMed machine is used, but that seems like a needless complication.
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#7
RE: How Does ResMed APAP distinguish OSA vs. CSA?
Thanks for pointing that out, I zoomed in on one of mine and could see it as well, and it had the expected pulse frequency (~4 Hz). The magnitude of the pulses was smaller than (~half of) the 1 cmH2O value cited, but definitely there.

I wonder if the term "Clear Airway" was retained because that is more literally what the pulse is identifying (i.e., a clear pathway to the lungs), as opposed to an actual lack of attempt to breathe (i.e., central apnea), although you'd think that the former implies the latter if breathing has stopped.
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#8
RE: How Does ResMed APAP distinguish OSA vs. CSA?
Great thread Smile
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