Is in-lab titration study needed for higher-risk patient who wants to avoid COVID?

[DevinJones]

Is a titration study needed in a sleep lab to determine the appropriate treatment device (BiPap or ASV) after APAP data showed clusters of many central sleep apneas and flow-rate waveforms that resemble Cheyne-Stokes breathing?

The patient is at higher risk of post-acute complications from COVID due to his medical history and age and wants to avoid infection in a sleep lab.

What options do higher-risk patients have to determine the appropriate device and settings?

Can these patients be titrated while they stay at home?

[Sleeprider]

There was some speculation early in the COVID pandemic that looked at whether BPAP and respiratory assist devices were useful in treatment of infected patients, but the concern at that time was a shortage of hospital ventilators for treatment. We don't see that at all anymore. Therapies like ASV, AVPAS and iVAPS are used to treat specific conditions and not as a prophylactic to a Covid infection. It seems your question is more related to avoiding contracting Covid while in a sleep study or titration study. To be completely honest, a search for COVID protocols for sleep protocols suggests that this topic ceased being an issue about a year ago, or at least no studies have been published since March 2021. Most labs and clinics have safety protocols in-place and are continuing to provide full PSG studies. Home studies became more popular during this period, but advanced respiratory titrations are not being conducted outside the clinics due to the cost of the machines and monitoring involved. During the COVID scare, most studies were suspended, and the backlog is just being accommodated now. Sanitation protocols should be sufficient or overkill for preventing transmission in the clinical environment. If this is an issue that affects you, contact the clinic and ask.

What we once thought was true about COVID has mostly been proven a lie. Vaccinations, boosters and masks are not a solution. So I guess we just have to live with it.

[DevinJones]

Yes, the patient has to avoid contracting COVID in a sleep lab that has stopped many COVID mitigation measures, including testing of patients and staff.

The topic is still a big issue for immunocompromised patients and others at high risk for post-acute complications. That hasn't changed.

Were ASV and BiPap titration studies being done in homes earlier in the pandemic?

If a patient needs an ASV device for clusters of CSA during APAP, can the patient be titrated at home without advanced respiratory titrations in a lab? Thanks.

[Sleeprider]

An ASV is a completely automatic device. Just set the machine to AutoASV and let it work. I am yet to see the individual I could not coach to optimized settings by observing one-night of Oscar data after using the machine...well, maybe two nights.

If you don't like labs or the medical mafia, ask me how you can obtain a machine on discount out-of-pocket, and DIY.

[DevinJones]

Thank you for the helpful info. Let me consider this and get back to you if I want to go the route you're suggesting.

[DevinJones]

One more thing: can someone who knows how to interpret APAP data via OSCAR tell from a night or two of data if an ASV device would be the more appropriate treatment device?

[Sleeprider]

Generally yes. People with patterns of central apnea, hypopnea and periodic breathing will show this in their therapy, and it will usually be worse with the use of higher or variable pressure, and EPR. We have seen people with central apnea eventually adapt to CPAP and improve results, however it is common for them to have a lot of arousals and unsatisfying sleep, along with some respiratory instability and unpredictable episodes of central apnea.

We are seeing a considerable shortage of Aircurve ST-A machines as they are positive air pressure ventilators that provide volume assured therapy and respiration rate backup. Apparently this is the choice of machine by individuals affected by long-term COVID effects. http://www.apneaboard.com/forums/Thread-...#pid469459

[Gideon]

What OTHER conditions do you have? Things like COPD where your minute Volume diminishes over time. In addition to some significant pulmonary issues these would include various neuromuscular issues. ASV is not indicated for these issues. While I agree that ASV does look like it may be appropriate I do want to make sure it is not contraindicated.

Here is a list of causes of central apnea from WebMD, do any of these apply to you, or something similar? I expect the answer is no.

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Central Sleep Apnea
Written by WebMD Editorial Contributors
Medically Reviewed by Melinda Ratini, MS, DO on January 15, 2022
What Is Central Sleep Apnea?
Central sleep apnea (CSA) is when you regularly stop breathing while you sleep because your brain doesn’t tell your muscles to take in air. It’s different from obstructive sleep apnea, in which something physically blocks your breathing. But you can have both kinds together, called mixed sleep apnea.

Central sleep apnea usually happens because of a serious illness, especially one that affects your lower brainstem, which controls breathing. In very young babies, central sleep apnea causes pauses in breathing that can last 20 seconds.

Central Sleep Apnea Symptoms
The main symptom of CSA is pauses in breathing. It usually doesn’t cause snoring, the way obstructive sleep apnea does.


Symptoms also include:

Being very tired during the day
Waking up often during the night
Having headaches in the early morning
Trouble concentrating
Memory and mood problems
Not being able to exercise as much as usual
Recommended




Central Sleep Apnea Causes and Types
There are several types of central sleep apnea, each with a different cause.

Cheyne-Stokes breathing. This is when your breathing speeds up, slows down, stops, and then starts again. Each of these cycles can last 30 seconds to 2 minutes. Cheyne-Stokes breathing is common in people who’ve had heart failure or a stroke. It happens in about half of central sleep apnea cases.

Narcotic-induced central sleep apnea.Opioid medications like morphine, oxycodone, and codeine can affect your breathing patterns.

High-altitude periodic breathing. Many people have trouble breathing when they go up to a high elevation, usually 2,500 meters (8,000 feet) or more.

Treatment-emergent apnea. About 5% to 15% of people who have positive airway pressure treatment for obstructive sleep apnea get CSA.

Medical condition-induced apnea. Health problems like heart failure, Parkinson’s disease, stroke, and kidney failure can cause CSA.

Idiopathic (primary) central sleep apnea. This is when there’s no clear cause.

[DevinJones]

what is the availability of the ResMed ASV device?

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No, I have no history of strokes, CHF, COPD, or other lung diseases.

[DevinJones]

How can I have the breathing pattern you can see in the attachments if I don't have a history of strokes, CHF, or other medical conditions usually associated with this type of breathing pattern?