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Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Mavan - 04-14-2023
Hi: My husband was diagnosed with OSA 15 years ago, didn't have good compliance at first. It's still a struggle, between mask fit, leaking from mask and mouth, and waking up out of breath, or taking his mask off in the middle of the night. He wears nasal pillows, and uses 8-11 pressure.
He had a massive heart attack Feb 2022, STEMI, 100% blockage of his left anterior descending artery. He collapsed on the sidewalk, brought back after 20 minutes CPR, coded in emergency, was put on a heart/lung by pass to get the stent in to bring him back, and was in medically-induced coma for five days, hospital for three weeks.
During his time in ICU on a ventilator, he experienced central apneas when he was partly brought to consciousness. They said that happens sometimes. His EF was 36% 11 days after his widowmaker heart attack, and 36% in early February 2023 with a cardiac MRI with contrast. His heart is quite badly damaged.
He's in pretty rough shape now. He spends most of his days in bed or lying on the couch, he's tired, weak, nauseated, in pain. He was diagnosed with cancer (multiple myeloma) six months after his heart attack, and started chemo in September 2022. I think the chemo has created further damage to his heart, he was doing better before that. He's on a chemo break for now, for maybe another month or so, but is only marginally improving.
Lately, he's developed a sore inside one nostril. Not from touching the pillows. For some reason humidity was set to manual and was at 3, so we increased it to 5 and 29C for temperature, hoping it will help, it's only been one night. Seeing the GP on Tuesday about his nose, and maybe we'll ask for another sleep study.
The respiratory therapists say he has central apneas, but they tried to treat it by changing his pressures. The latest is saying he's having more central apneas, and when he stops breathing, because there's no obstruction, the pressure is clearing the CO2 out of his lungs, making him less likely to take a breath. So we'll see about getting him another sleep study (he has had two in the hospital both over a decade ago).
We have extended medical, so can get whatever new machine he needs.
And I will download the data from his CPAP and try to download OSCAR to add his data, and figure it out, and share it here. It's overwhelming, I just learned about OSCAR this afternoon.
So just wondering about next steps, getting him the help he needs. Is a sleep study important if he won't qualify for an ASV machine with his low EF? Is there hope?
Thank you for reading this far.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Jay51 - 04-15-2023
Thank you for posting that. His LVEF may still be too low for ASV. A machine that can ventilate (provide back up breaths) could combat CA's. Ventilating type machines like ST, ST(A) or IVAPS or AVAPS can do this. With a set back up rate of say, 15, a machine like this could force him to breathe every 4 seconds and prevent CA's. And these machines can treat OSA also. IVAPS and AVAPS can even boost his tidal volume (amount of air he inhales in a single breathe) also. Many more options to try IMO.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Mavan - 04-15-2023
Thank you Jay. I had no idea there was such a variety of machines like this, this is reassuring.
I'm hoping that when we get referred to the pulmonologist at the sleep clinic, they'll know all this and be able to offer him treatment that can help him.
It sometimes feels like a game of hot potato with his specialists, oncology says it's his heart contributing to his lower quality if life. Cardiology says, he was healing before he started chemo. In the end, we changed oncologist a week ago because the previous one said just keep going for three more cycles, or you can quit and have no treatment until the cancer comes back. And no one is even asking about his sleep apnea.
Though we did speak to his palliative care doctor yesterday who will write to his GP requesting an urgent referral to the sleep clinic and a specialist.
Thank you again.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - srlevine1 - 04-16-2023
I will say a special prayer for you and your husband tonight.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Mavan - 04-30-2023
I was finally able to install OSCAR on my daughter's computer and upload the data from his CPAP machine. It feels like information overload. This past week, he has had so much trouble sleeping, so the data doesn't look so great.
Where do I start? What should I share? Thank you!
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Mavan - 05-01-2023
Since I'm new, maybe I don't have the ability to edit my initial post, but I can't figure out how, so I'm adding a reply.
Here is a report of a bad day with lots of central apneas:
[attachment=50258]
And here is a summary of his CPAP data from OSCAR. Trying to figure out how to extract more information
[attachment=50259]
He's hardly able to sleep any more with his CPAP. He's really struggling.
We're seeing the GP on Tuesday for an urgent referral for a new sleep study. We've been working closely with the respiratory therapists at the CPAP store in Vancouver, BC. And we tried a new mask, didn't work, have to exchange, and are looking at options, but really trying to understand the role that central apnea is playing.
Any and all help much appreciated.
Thank you!
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Jay51 - 05-01-2023
Organize your OSCAR Charts Thank you for posting your husband's OSCAR summaries. I hope that you can click on the link I just pasted into this post. It shows how to best organize and upload an OSCAR chart that has the best data to analyze on it.
Most machines treat obstructive apneas, but if your husband's sleep study reveals a high level of central apneas, a machine that provides a back up rate (it breathes for you when you miss a breath) should be prescribed for him.
Any other questions, just ask.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Mavan - 05-01-2023
Thank you Jay. Yes, the link works. I'll read through that, and extract more data to share.
I especially want to extract good information to send to the sleep doctor so they can evaluate the urgency of getting him a new sleep study.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - Ivy woods - 06-02-2023
So sorry to hear your husband is not doing well. I hope he gets the help he needs. I have read about over ventilation causing central apneas and my husband lowered his pressure from 11 to 5.4 and central apneas almost vanished. I have suspected that his issue was too low a carbon dioxide level in his lungs which lowered his instinct to breathe. Your comments add to that information, so thank you very much for sharing it. Best wishes to you and your husband.
RE: Central Mixed Apnea - Diagnosis/Treatment with 36% Ejection Fraction - kappa - 06-02-2023
Sorry to hear about your situation Mavan. Looking at the historical data it appears that AHI jumped when EPR was enabled. It may be worth changing the settings to disable EPR (when can exacerbate CAs) and perhaps switch back to fixed 12cm which had the best stats (or to auto 7-12 if fixed 12 is uncomfortable after disabling EPR).