Newly diagnosed husband mixed events ahi 81, need advice

[Artapnea]

Husband recently diagnosed via Lofta. Total ahi 81

Obstructive is severe, ahi 56, 02 lowest at 56%

Central is moderate, ahi 25

Cheyne Stokes respirations 36% of the study

I was after him for 10 years to get a study. Refused to go into a place to have it done. Finally agreed to do the at home test.

Looking at machines. First was recommended the resmed ST. But I read up and saw the resmed ASV is really the machine for all his issues, and looks like it auto adjusts without him having to do it himself.

We know he needs the echo ASAP if we go with the ASV. 

Ideas? Advice? Comments?

[Gideon]

Welcome to the AB
I assume this is a diagnostic study.
I think you are using the wrong terms
'Obstructive is severe, ahi 56, 02 lowest at 56%'
is the 56 the overall AHI or only the OAI I think the OAI as you say the total is 81
'The Central is moderate, ahi 25'
I think you mean the CAI is 25.
'Cheyne Stokes respirations 36% of the study'
I assume this is accurate as CSR and not just periodic breathing. This is of concern. Does your husband have CHF? This amount of CSR frequently goes with CSR. There is also a need to know if there is a history of brain injury, stroke, seizures, pain medications or related meds. These issues need to be discussed with your doctor because of the centrals and the CSR. Also any cardiac and/or respiratory illnesses?

'02 lowest at 56%' below 88% for a period of time is a definite concern and calls for supplemental oxygen. A single low spike is typically of no concern but any sustained period(s) of low O2 is. Because of this, I suggest a recording pulse oximeter so you can determine if this is an ongoing issue after you are on CPAP.

What specifically is his diagnosis? Frequently is cases such as this we see incorrectly diagnosed as simple OSA. It is very important that your diagnosis acknowledges the centrals.

[Artapnea]

He doesnt have anything else wrong with him besides being tired. That we know.

He’s not on pain meds, etc.

[Gideon]

Good start, glad to see the CSA diagnosis.  

a conservation with your doctor.

My understanding is that a ResMed ASV is the best for Central Apnea.  I also understand that a ResMed ST is often used as a stepping stone.  Is it feasible to skip the ST and go to an ASV Titration to prove efficacy with that instead?  

Note how you are leading and requesting the doctor's confirmation of direction.  

A followup, what is the long term plan for us to get this central apnea treated?

What modes are used to treat what?
ASV Auto is what you want.

This is from our Wiki http://www.apneaboard.com/wiki/index.php...estriction

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  

[Artapnea]

Yesterday after I did my research (and concluded the ASV was the best for his diagnosis, at least according to the ResMed site) I spoke with the actual sleep doctor and he said the ASV would be the best machine to go with if we could afford it. So he wrote me up an invoice and we are mulling it over and how to pay for it. He is re-writing his script for the ASV.

We are asking for the cardiology referral ASAP. Due to places not even scheduling appointments it might be a while though. He did an echo and stress test a couple years ago and everything was fine with his heart. He’s been doing that Cheyne Stokes breathing for a few years.

[Gideon]

Ask if you need the cardiology referral, the study that required is considered flawed by many and there is a new study in process that looks like that restriction may be overturned sometime this year.
With the COVID-19 going around with the lack of studies happening. Ask, maybe lucky.

[Artapnea]

Thanks. I’ll probably just want him to get checked out at some point because of the CS respirations. Seems like those might be heart related.

Thanks so much for your help.

[Gideon]

Has he had his LVEF checked before?

[Sleeprider]

Artapnea, I don't know what your insurance looks like, but let me offer some alternatives to the quote for the ASV machine. I will only quote Resmed Aircurve 10 ASV as it is the easiest machine to use and the one we have seen provide superior therapy through hundreds of members here that use them. With all due respect to Philips Respironics, we see much more difficulty for users to adapt to them and significantly higher residual AHI.

Supplier #2 sells these new for $2149 USD and lightly used with a warranty for about $1319. I encourage you to consider the used machine which will come with great customer service. Call them Monday and ask any questions at 855-263-2727.

Another option can be found on the DotMed website. This is not as user friendly and will not have a warranty. You have to go to the site and look under Respiratory Devices and the BiPAP category. It is being sold for $850. The seller says it is in excellent condition "almost brand new", but does not state the run hours. We have had another member purchase a machine on this site recently and he got excellent results. Worth a try if saving money is important.

Finally, let me say I'm so glad you educated yourself regarding machines. The ST is not an appropriate choice for central apnea, and we have seen many people struggle to make these work. The ASV will immediately resolve the complex apnea with obstructive, central and CSR events. You may be aware that ASV is contraindicated for congestive heart failure with left ventricular ejection fraction less than 45% due to a higher mortality rate noted for this cohort in the SERVE-HF study. I want you to know that those results are highly questionable and a newer study ADVENT-HF is finding no increased risk from use of ASV in CHF patients. Please feel free to discuss if this question arises with your husband's doctor.

[Artapnea]

Hello,

Does Supplier #2 (good price!) set up the machine according to the prescription? 

Thanks for this, if we go with this site it'll save us tons of money. I am going to give our insurance company all this stuff after we get him secured with the machine ASAP. His safety is my primary concern, although I was concerned about having to finance a machine that costs more than one of our cars.