Do I have Central Sleep Apnea?

I'm looking at my sleep study results:

AHI Index is 46.1

Stage R AHGI Index is 55.6

I had 60 central apneas but only 10 obstructive apneas

The Diagnosis says "Sever Obstructive sleep Apnea", yet I question that diagnosis based on me having 6 times as many central apneas as obstructive apneas.

Do you have some way of posting an image of the sleep study report? If you have an image file you just left click on it and drag it into the body of a post.

Some of the terms you have uses are not familiar to me. AHI is standard and the 46.1 fits you in the severe apnea range. It would include all apnea types and hypopnea. Stage R AHGI is a term I do not recognize. Your event count does not make a lot of sense. Say that you slept for 6 hours and had 60 central apneas then the CAI (central apnea index, events per hour) would be 10 (60 divided by 10). However the obstructive index would only be 1. This would mean that the majority of the other events that make up the AHI would have to be hypopnea, and they have assumed they are obstructive in nature.

In any case, a CAI in the range of 10 is high, and cause for some concern. It is possible that some or perhaps many of the hypopnea events may be central in nature instead of the assumed obstructive.

You should get a copy of the sleep report and seek a second opinion on what it means. The issue is that standard obstructive apnea treatment using a CPAP or APAP is not very effective and can even aggravate central apnea.

Not a medical professional, but those are my thoughts based on what I know about it.

What follows is the main part of my sleep study:

Protocol: This sleep study included the recording and monitoring of frontal, central, and occipital EEG, EOG, EMG, ECG, respiratory effort and flow, snoring, pulse oximetry, and position. Video recordings were obtained as needed. A qualified technician continually monitored patient throughout the night. Data was digitally stored and tabulated using Alice 5 software. Sleep staging and respiratory events were scored manually using AASM standards.

Sleep Latency: The patient’s sleep onset latency after lights out was 22.5 minutes. The Stage R sleep latency from sleep onset was 110.0 minutes. Total Sleep Time: The total time in bed was 376.0 minutes with a total sleep time of 244.5 minutes. Sleep efficiency was 65.0 %.

Sleep Architecture: The patient had 41.0 minutes of Stage R for 16.8% of TST, 37.0 minutes of Stage N1 for 15.1% of TST, 166.5 minutes of Stage N2 for 68.1% of TST, and 0.0 minutes of Stage N3 for 0.0% of TST. The arousal index was 5.4 per hour of sleep.

Respiratory: The patient was observed to have had a total number of 188 apneas and hypopneas with an AHI index of 46.1 per hour during total sleep time. The Stage R AHI index was 55.6. The normal AHI index is less than 5 per hour. There were 10 obstructive apneas, 0 mixed apneas, 60 central apneas, 118 hypopneas (4% desaturation or greater), 0 central hypopneas, 0 obstructive hypopneas and 5 RERA’s. The total RDI (A/H + RERA’s) was 47.4. Mild snoring was noted for 28.6% of TST. A split-night was not conducted due to physician order stating PSG.

Oxygenation: The patient had an average oxygen saturation of 95%. The minimum oxygen level was 83%. *Masimo Pulse Oximeters are accurate to a low SpO2 of 70% (+,-3).

Cardiac: The average heart rate was 55.6 beats per minute. The patient had a normal sinus rhythm with no arrhythmias noted.

Other/EMG: Patient had evidence of periodic leg movements during sleep. Patient had a total of 93 PLM’s with a PLM index of 22.8 and a total of 14 PLM arousals with a PLM arousal index of 3.4 per hour of sleep.

Diagnosis: Severe obstructive sleep apnea (G47.33) with an overall AHI of 46. Nocturnal hypoxia (G47.36). Abnormal sleep architecture with evidence of reduced of delta sleep. Patient did not qualify for split night (CPAP trial) protocol. There were significant periodic limb movements (G47.61) with a PLM index of 23.

Recommendations: Treatment for Obstructive Sleep Apnea is indicated to prevent cardiovascular morbidity and effects on daytime performance. Treatment options include CPAP/BiPAP, dental sleep appliances, upper airway surgery and neuro-stimulation. Until successful treatment has been established patient should be advised of the risk of driving or operating heavy machinery. Conservative therapy may also be helpful including weight loss, avoiding alcohol or sedatives prior to sleep, cool and totally dark bedroom, and trying to maintain a regular sleep pattern. Patient should return for a full night CPAP/BiPAP titration to optimize pressure settings if patient elects to have PAP therapy. Auto-PAP device set at 6-20 cwp should be considered while awaiting definitive titration or as an alternative to CPAP. Further evaluation and treatment of Periodic Limb Movements should be considered if they continue to cause arousals despite successful treatment of the obstructive component of the patients sleep disorder.

Sierra,

Curious that neither the sleep tech or my doctor observed that the dominant component of my high AHI was central apneas. Makes me think they don't know what the bleep they are doing.

Heaven forbid that a patient who knows nothing about reading these results would have to point this out to them.

Since they already ordered me an APAP, I'm wondering if that would help me diagnose central apneas, or not.

FWIW, my sleep study (a home test) indicated a preponderance of central events too with similarly high AHI results.

As soon as I started therapy however my numbers dropped into the "normal" range (5 or <) almost immediately and even though CAs continue to be my "wildcard", and I occasionally have a poor night (still even then never over say a total AHI of around 6), my averages over the past 3 months on my current machine are CA: 1.2, OA: 0.8 and overall AHI (including "other"/hypopneas) is 2.4. Suggest you give it all a chance, do the therapy, read all you can, exchange ideas on sites like this (e.g. with folks like Sierra who's input I have found particularly helpful), and follow your instincts to tweak your therapy accordingly.

I will go ahead with the APAP (not sure which one I will get yet) and I will keep an open mind and see how much it helps me. I will be sure to ask about returning the APAP if it turns out an ASV is more appropriate for my condition.

All of you have been incredibly helpful and I appreciate your responses so much!

I hear you on that last point. I got so fed up with BCBS and their exhausting rules, misinformation and manifest incompetence that I finally just bought my own machine direct from Lofta and freed myself from the tyrrany of a crappy insurance provider.

My diagnosis was mild obstructive, AHI of 8. 28 hypopneas and 18(?) central apneas. I went with an Apap and find my numbers are now generally under an AHI of 2. Typically between 1 and 1.5 with most of them being central in nature. My pressure is rarely over 6 or 7 which probably helps to minimize more centrals being brought about.

I don’t feel any more well rested than before but that’s another matter.

With respect to the centrals, the neurologist I’m seeing is also a sleep doctor. He explained to me that sometimes the centrals are more to do with sleep and wake transitions than with a true central apnea related to heart or brain stem issues. The more sleep disturbances you are having due to hypopneas or obstructive apneas (or even non sleep disorder awakenings) the more opportunity for central apneas to occur. I’d not be afraid to try an apap, particularly if you can exchange it for a different machine if you wind up needing something more advanced. Sierra suggested this to me and it worked well in my case.

Your neurologist's comment regarding entral sleep apneas and sleep transitions is interesting as that is what I believed I was seeing in my data.

It's worth remembering that events which appear to be (and are therefore scored as) central events on a diagnostic study are not necessarily central. Also, it is indeed possible, although unusual, for central events to be treated by CPAP. So there is a very sensible and well-established protocol to try CPAP as a first step in treatment regardless of how the diagnostic study looks. This is the best way of being certain if they really are central events, and can also yield some data that is very useful in applying BiPAP to treat central apnoea. Of course, this is best done in a lab, where someone is watching and can swap to an appropriate Bi-level therapy if CPAP is ineffective and there are clear central events. It can also be done by trying CPAP at home, but this is much slower. In your case I noted that there is an increase in you AHI when you are in REM. This is strongly indicative of obstructive apnoea and not central. I would suggest that your physician and technicians might know what they are doing and are following the appropriate protocol. The real test will be how they respond based on how well your treatment works.

The Auto CPAP has been unable to even come close to getting my AHI under 5. The Central Apnea component is especially out of control. Over the last 11 days my AHI is averaging around 20 and my Central Apneas are about 5 times more than the obstructive ones.

Do I need an ASV? And if so how do I justify it to my doctor and insurance?