complex sleep apnea

[jb1991]

As i was taught, you will only see CSA during the CPAP titration. Am i correct in thinking that you would not switch them to ASV during the titration, but, instead, bring them back for a full night with the ASV? I have one doc who is insisting that we switch the patient to ASV or BPAP ST, and another doc who says dont treat the central apnea at all. Thoughts?

[jb1991]

I believe I found my own answer.....you can switch to ASV as long as they meet criteria for Complex SA......i think i remember during the in-service the rep said it wasnt recommended.....

[bduce]

Start with your respective docs definition of "complex sleep apnoea" as there are different definitions used out there.

If it CPAP emergent centrals then you put them ASV for 2-3 months and then repeat the CPAP study. For some the centrals will have resolved for others they will still be present. For those with centrals persisting then keep on ASV. Or you could just leave them on CPAP for the 2-3 months then restudy them. However a number of patients will find continuing with CPAP for those 2-3 months difficult.

If they have cardiac comorbids then ensure that they are on maximal therapy before going to ASV.

Food for thought...

[jb1991]

Right. And i think that is the thought of our medical director. Treat with CPAP and if not tolerated or central still present then do ASV titration. The doc i am having trouble with is new to reading studies in our lab, not boarded, but has "experience". I think I am going to defer to my medical director for guidance.

[dakota]

In our lab, if a patient is having frequent centrals, we can trial BiPAP. They want us to trial BiPAP for at least a couple hours. If the centrals are persisting (more than half the events seen are centrals), our medical director wants us to trial a backup rate first, and if that does not work, then trial ASV if time is available (more than a couple hours). Of course, check with your medical director and see what (s)he wants you to do. Usually, there is not enough time for us to do a CPAP-->BiPAP-->BiPAP ST-->ASV in one night, but some nights there are. I strongly feel that the central apneas need to be treated, but sometimes the central apneas go away once a patient has been on CPAP for awhile, so I can understand some doctors' reservations to treating CSA.

As far as only seeing CSA in CPAP, I see CSA in baseline studies, particularly with patients who have abused narcotic pain medications, ex-heroin abusers, and people with severe heart issues. My niece has central sleep apnea due to a medical condition (MELAS) that causes strokes.

[jb1991]

I have a sample epoch of respiratory events that i would like some opinion on, but I cant upload the file? Any thoughts?

[MrBig]

As i was taught, you will only see CSA during the CPAP titration.

[MrBig]

I have a sample epoch of respiratory events that i would like some opinion on, but I cant upload the file? Any thoughts?

You could upload the image to ImageShack, then paste it here....

[jb1991]

whats the double facepalm mean?

[jb1991]

and i guess i should have proofed my earlier post... i meant complex sleep apnea, not central sleep apnea.

[KendallStation]

lol @ Big,

There's a lot of thinking lately that what used to be "Complex Sleep Apnea" is really just emergent centrals in light of the PT acclimating to CPAP. Also, some PTs just have 4-5 centrals after turning over etc... Check the medicare requirements for ASV, you'll see that most of these "complex" cases aren't covered. More importantly talk to your docs and get a definition.