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Re: Optimum pressure caveats, indeed!!

Posted by - Sleepy Coote on February 14, 2003 at 11:13:45:

In Reply to: Re: Optimum pressure caveats, indeed!! posted by Rebecca on February 14, 2003 at 10:01:56:

Hi Rebecca. Somewhere I think you misread---or perhaps I miscommunicated. My responsive AHI is greater than 5 at a minimum pressure of 9; as my minimum pressure is set lower and lower my responsive AHI increases as is the usual case for OSA patiennts. I am sorry if I somehow described this unclearly. Greater air pressures can only thrust the airway open better than lower pressures under any circumstances---therefore fewer obstructions, never ever more closures. If greater pressures induce apneas, these are always centrals.

In my example, however, I hypothetically cited a patient with pure OSA events when untreated. In this hypothetical example the patient had no centrals until after his/her optimal pressure had been reached. That example more closely approximates the static model. However, we know that many patients who start off with purely obstructive OSA eventually get around to also having central apneas----even at their "optimal" pressure. That is because the "optimal" is still a constant and can thus only be "optimal" in a static model. As I pointed out, the dynamics of the physics equation dictate a surplus of energy (air pressure) at many different moments in time. The reality of static air pressure being used to treat dynamic needs (and the moment to moment dynamics of over pressure) are precisely what, in my opinion, cause purely OSA patients to eventually become "mixed apnea event" patients (obstuctives plus centrals).

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