What is a bad total for CA's?

[Allessio77]

After a month of APAP therapy (and while I wait for my doctors appointment on Jan 10), I am curious about the number of CA's in a night that would constituent concern.

Here is some monthly data:

Average CA's per night: 12.5
Number of nights above 30 CA's = 3 nights (32, 34, 30)
CSR = 3 nights for a total of 54 minutes (14, 17, 23)

% of Apneas that were CA's = 68.8%

Monthly Average AHI = 2.57

SpO2 Desaturations = 6 nights for a total of 105 minutes (27.4,  8.4, 2.9, 10.3, 13.1, 43.7)

This data is all while on my APAP.




Any comments or assessment would be appreciated.

[ajack]

The CA rate is fine. They are probably new user and will settle down even more. If they weren't there in your sleep study. AHI under 5 is considered treated. You need to put some sleepy head charts up, to tidy up the desats. With a low AHI, I would be looking at the chart and not the report. I don't know what one you have, but my cms has glitches.

[Allessio77]

The CA rate is fine. They are probably new user and will settle down even more. If they weren't there in your sleep study.  AHI under 5 is considered treated. You need to put some sleepy head charts up, to tidy up the desats. With a low AHI, I would be looking at the chart and not the report. I don't know what one you have, but my cms has glitches.

I had 73 CA's in my original sleep study and and AHI of 30. I had 43 CA's in my titration study and a 25.6 AHI. But the doctor wants me to retest due to having the original test at 3500 ft higher in altitude than my residence.

I just want to make sure I am in no danger while waiting for this retesting.

[ajack]

Well your CA rate is fine now. on the left hand column, click on events and then CA, see how long they last. If under a minute. I wouldn't give the few you have, a second thought.
The only thing I would want to check is the O2 chart, to see what it is reporting. It may be movement of more than 4% or a glitch, neither are important. Time under a true 90% is to be looked at

[Sleeprider]

We have not seen much of your data, but your results have consistently shown a mixed or predominately central apnea tendency on the Airsense 10 Autoset. Your pressure is set to a 5-15 range, and I think EPR is at 1, and your summary data shoes your pressure remains consistently below 9 cm. There is one data point on Dec 18 that it appears you used fixed pressure at 5.0 cm, and had almost no CA events. That might be a worthwhile experiment to repeat. If you have very low events at fixed low pressure with no EPR then you have probably found an effective therapy solution. It's possible you would respond to ASV, but your event rate is currently under 5 AHI consistently, and frequently less the 2 AHI, so I would be surprised to hear that comes up at this point.

I think your doctor wants to confirm that you have predominately central apnea, and is trying to rule out altitude as a cause. I suspect any new study will show similar results given what we're seeing here. I also think you could potentially have nearly no events if you use fixed pressure, or limit your range to 5-7 cm without EPR. As far as your health is concerned, I don't see how this event rate or time in apnea would be a problem. An oximeter could provide data to backup any potential risk. At most you are waiting several weeks for re-testing, and you have likely had this problem for a fairly long time, most of that untreated. Your current event rate is much better than your untreated rate from the test results you mentioned.

[HalfAsleep]

A lot depends on when events happen, how they cluster, what all you have going on with your breathing, relationship to mask leaks, etc.. It's important to look at charts for one day at a time.

[Mosquitobait]

CAs are really common if you are tossing and turning. Given how many you had in your lab assessment, it is something to bring up to the doctor when you have your follow-up, particularly if that pattern continues. I only had about a dozen CAs in my lab assessment and I think as many as 6 in my first month, but now I only occasionally throw one and that isn't concerning at all. However, healthwise, you aren't going to keel over from that number, so breathe a sigh of relief on that. Continued higher level CA, as Sleeprider indicates, may recommend a different machine. Given the much higher costs of other machines, they aren't going to push it on you unless they feel you will benefit substantially from it.

[Allessio77]

Well your CA rate is fine now. on the left hand column, click on events and then CA, see how long they last. If under a minute. I wouldn't give the few you have, a second thought.
The only thing I would want to check is the O2 chart, to see what it is reporting. It may be movement of more than 4% or a glitch, neither are important. Time under a true 90% is to be looked at

Ajack,last night my total CA minutes were 6.68 minutes.

My O2 showed 67 desats for a total of 47.3 minutes

This was one of the worst nights in the month.

[Allessio77]

There is one data point on Dec 18 that it appears you used fixed pressure at 5.0 cm, and had almost no CA events.  That might be a worthwhile experiment to repeat.  If you have very low events at fixed low pressure with no EPR then you have probably found an effective therapy solution.  It's possible you would respond to ASV, but your event rate is currently under 5 AHI consistently, and frequently less the 2 AHI, so I would be surprised to hear that comes up at this point.  

Sleeprider, My data on Dec 18 was corrupted and did not transfer to SH. That was also the case on 12/10. The pressures were not really fixed on those nights...I just don't have the report.

[Sleeprider]

Alessio, It looks like your doctor wants a second diagnostic study to see if the first study had an error due to altitude. Your CPAP shows that while your AHI is much better controlled, the events continue to be predominately central. Your oximetry shows this has an impact on your oxygen levels. I think the duration of CA events, how they line up with desaturations, and how you feel are important issues to get in front of your doctor as well. If you are having long events, with significant oxygen desats, and you continue to be tired, then you should be arguing for a titration study on ASV not a second-guess diagnostic.

If you have a titration study rather than diagnostic, the events and type will be evident on the study, and it can be determined if you benefit from ASV. A diagnostic study is going to do nothing, but confirm or modify the original findings, putting no closer to a therapy alternative than you are today. With an average event rate of less than 3 per hour, the challenge is going to be justifying ASV therapy. That is why the numbers are incomplete without the duration and oxygen desat statistics, and how you "feel" in response to CPAP therapy. A titration study at least moves the game forward.

If you are open to trying something different, then I still think a fixed trial at 7 cm or using a limited APAP range of 5-7 and turning off EPR would be useful.