Diagnosing Hypopnea Events

[Geer1]

I recently underwent a sleep test and the results scored me as moderate sleep apnea with an AHI of 16.3 and oxygen saturation falling to 75%.

I believe the details of my results do not indicate normal obstructive sleep apnea caused by throat/tongue blockage though as I do not snore often and out of my 143 apnea/hypopnea events only 3 of those were obstructive apnea’s, 4 central apnea’s and the rest hypopneas.

I believe I will be receiving a cpap machine this week but I would like to try and understand what is causing these hypopnea events.

I believe I have some sort of chronic sinus issue and I imagine it may be the cause of hypopneas as my nose often feels stuffed up. I see an ENT next month so will hopefully learn more about this then. I imagine if my hypopneas are being caused by this sinus issue or a partial closure of throat etc that cpap should improve my symptoms.

If cpap doesn’t improve hypopneas then I imagine they are caused by a central issue. What I was wondering is if there is anyway using OSCAR to help distinguish between central and obstructive hypopneas? If not I imagine you just increase cpap pressure until they either go away or don’t get better?

I am not writing off central hypopneas as a number of my symptoms are nervous system related. From my research these symptoms may be due to the low oxygen levels I have been having during sleep or the sinus issue so obstructive apnea is still the first cause to try and rule out.

I would just like to hit the ground running with my apnea treatment/diagnosis so any pointers on how to diagnose hypopneas further on my own would be appreciated. I’ve spent over a year waiting for this diagnosis and our medical system takes so long I want to be on top of things.

I am considering purchasing an oximeter to help track oxygen saturation, with that and ResMed autoset looks like I would have all the details an in home sleep study provides(like the one I had done). Wellue o2 ring looks intriguing after seeing another member post about it but I am open to other comments/recommendations.

[Julie]

Did you mostly sleep on your back? Ever tried to not do so?

[Geer1]

Did you mostly sleep on your back? Ever tried to not do so?

During sleep study I slept on back for 6 hrs, side for 2.5 hrs. I sleep on side to start but usually switch to back at some point during sleep, if I wake up I usually switch back to side again. I had hypopnea events both on back and side during sleep study.

Obvious first step is to try cpap and see if it helps. Just curious if others have tricks to diagnose hypopnea since they are a symptom not a cause.

[Julie]

Back sleeping generates/provokes many more events (apneas/hypops) so many try to not do it if they can, by eg. wearing backpacks stuffed with pillows, and/or using a foam wedge in behind for when they (in their sleep after all) flip onto their back, etc. etc. Just an idea... though usually raising min. pressure helps to get rid of too many hypops.

[Pugsy]

Hyponeas are just flow reductions that don't meet the criteria to earn an OA flag.

Obstructive apnea....reduction in air flow from 80 to 100% that last at least 10 seconds.

Hyponeas....reduction in air flow from 40/50 % to 79% that lasts at least 10 seconds.

They are indeed part of the diagnosis criteria for OSA. They are indeed very important and can cause desats and awakenings just like full grown OAs can cause.

Think about it...do you really think that there is that much difference in terms of damage to the body between a hyponea at 75% flow reduction and an OA at 85% flow reduction?

Hyponeas are part of the diagnosis criteria for sleep apnea...they aren't a symptom of sleep apnea.

[Geer1]

I'd rather not argue over definitions, I consider it a symptom as it can be caused by OSA or CSA. The type of hypopnea was not differentiated on my test. Shallow breathing, minimal snoring, next to no obstructive apneas, never waking up with gasping/choking sensation, and other symptoms have me curious. I obviously have sleep disordered breathing but not sold on OSA yet.

I believe the place that organized sleep study just wants to sell me a CPAP. Based on my research it won't help me if it is not OSA so I am definitely going to push to start with a trial rather than buying a unit outright.

What I am curious about is during trial period if it is possible to use OSCAR to diagnose between central and obstructive hypopneas and if so any pointers on how to do so.

It is an Obstructive Hypopnea if ANY of the following are present:

Snoring during the event

An increase in the flatting of the nasal pressure flow or PAP flow signal

Paradoxical breathing

You can only call the event a Central Hypopnea if NONE of the above is present.

[LSAT]

I think you are in denial and are looking for reasons not to use a CPAP. Hypopneas are part of the AHI calculation...you still stopped breathing every 4 minutes. You have Sleep Apnea. CPAP will resolve hypopneas as well as obstructives.

[TropicalDiver]

I think you are making this harder than it needs to be. Regardless of whether your events are central or obstructive in nature, the answer will almost certainly be PAP. The question becomes which precise type of device/therapy. (I am assuming that the sleep study was not able to differentiate obstructuve from central)

There are two decent ways to determine that: a) do a titration study in a lab; or b) start therapy. Playing the odds, yours are way more likely to be obstructive in nature. In that case, a machine like the AirSense Autoset (or Autoset for her) would be a great choice. If you need higher pressures or greater exhale relief, perhaps something like the AirCurve Vauto. If the centrals (and if there are many) are not resolving, something like the AirCurve ASV.

How do you know? Start by working on the obstructives and see what remains. That can be done in a lab or it can be done with a machine at home.

You have sleep apnea -- the only question is what form of PAP is best.... And I want to emphasize that it is a fairly low percentage of patients who end up having a significant portion of centrals (to where they need an ASV).

Used or new is a more complicated question.

[Pugsy]

What I am curious about is during trial period if it is possible to use OSCAR to diagnose between central and obstructive hypopneas and if so any pointers on how to do so.

No...because the software just reports what the machine records and no machine will/can tell if a hyponea is central in nature or obstructive in nature.

[Geer1]

No...because the software just reports what the machine records and no machine will/can tell if a hyponea is central in nature or obstructive in nature.

I was thinking more along the lines of figuring out how to interpret the flow and pressure trends manually. I figure hypopneas are probably too difficult for a machine to interpret consistently but was thinking maybe they can be determined manually (for example my machine interpretation in sleep study was 9.5 ahi but after manual review was increased to 16.3).

I’ll post a video once I get a chance to edit it. Curious about my twitches prior to arousals.

Little more context, I have had tremors for a decade now and worsening neurological symptoms the past year(some facial numbness/paresthesia, what I believe is peripheral neuropathy, believe my vision has been affected at times too). Contrary to belief I can’t wait for CPAP and I hope it solves/improves these issues, if it does I imagine would have to be due to damage from oxygen desaturation. I am just not convinced yet and too busy overthinking everything while waiting for equipment...

Anyways CPAP appointment this week, Holter and cardiologist later this month(based on ridiculously high heart rate during sleep study) and ENT next month. Hopefully can get to the bottom of things. Tried talking doctor into full sleep study but he said would take too long and just to proceed with cpap.

[Julie]

For you to assume peripheral (facial... not very 'peripheral') neuropathy is due to bad oxygenation is a bit hard to just go with... what does your MD say? Have you actually been diagnosed with either problem? Are you diabetic? A lot of terms are being thrown around but who's coordinating your care?

[Geer1]

For you to assume peripheral (facial... not very 'peripheral') neuropathy is due to bad oxygenation is a bit hard to just go with... what does your MD say? Have you actually been diagnosed with either problem? Are you diabetic? A lot of terms are being thrown around but who's coordinating your care?

Exactly.

I am on my 2nd GP and have seen a neurologist, an internist as well as others medical personnel (chiropractor, audiologist, optometrist, dentist) to look into ideas doctors have had. For the most part I have been stuck coordinating as the doctors would rather argue I am healthy than keep digging to figure out what is wrong. GP's were blaming anxiety/depression but with encouragement they continued to send me for more tests/specialists. I was sent to see a neurologist who did a ct, claimed my tremors are essential tremors and that my symptoms don't fit any neurological disorder. He said it might be meds(was on antidepressants) or possibly sinus related, also said no point in coming back in so I haven't seen him since. GP won't sent me to another neurologist because I have already been checked sufficiently in his eyes(as you can tell I disagree). I tried another medication then stopped taking antidepressants all together and have been off them for ~2 months with no change or adverse affects(I had bad anxiety last fall because of these issues and thinking I was going to lose my job as I am not functioning like I should be, boss has been great in helping me figure this stuff out and it has relieved the anxiety). I have been on a 6 month waiting list to see ENT who I finally get into next month, I have tried daily nasal rinses, nasal corticosteroids, antihistamines, leukotriene inhibitors and decongestants, all help a bit but none solve the issue. Auto immune disorders are not uncommon in family, Parkinson's also in both sides, have been tested for diabetes and thyroid multiple times, never positive(thyroid values have changed significantly within normal range but never out of normal range), I see cardiologist has requested to test both again prior to my visit with him.

Internist did some blood work and was the one who ordered the sleep apnea test. Sleep apnea test took a long time to get results meanwhile blood work was all good and he claimed there was nothing wrong with me then sleep apnea test came in confirming some sort of sleep disordered breathing so he changed tune a bit. After recommendation on here and from another doctor friend I requested holter test through him(sleep study showed 226 bpm max) which he lined up.

I see current GP this week and am hoping he will start to coordinate things now that we have something figured out as the internist is really tough to get into.

Here is the video I mentioned. 10 examples from a single nights recording. Obstructive apnea not necessarily apparent although at a few times you will notice how my breathing sounds sort of nasally, sometimes my breathing seems to be light/hardly noticeable too hard for me to draw any conclusions from though. What I found interesting is that almost every awakening I have a limb jerk(arm, leg or sometimes head) during or prior to awakening and I am curious if that is common during OSA (brain reacting to low oxygen level etc) or something I should look into further (I will mention it to GP this week maybe show him video)?

https://youtu.be/7of3kcFadss