Watch Pat Questions

CPAP, BiPAP, and other sleep systems

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Postby linuxgeek » Thu Feb 05, 2009 12:35 am

As a measure of the autonomic nervous system, I think it's a very useful tool, and I think only mildly understood. It has a lot of promise, and I am certainly open to new possibilities. But, it's also difficult to be open to new technologies that don't show you any of the raw data and just output an AHI.

I would guess that it's not measuring increases in blood flow, but decreases in blood flow. Essentially, vasoconstriction from sympathetic discharges following a respiratory event. The problem with that is, there are lots of things that cause vasoconstriction, not the least of which is a "hunting response". This is the body trying to maintain a temperature at the periphery.

And, there's probably lots of things that cause autonomic activation AND arousals, including insomnia, PTSD, etc. And some people can have apneas and almost never have an autonomic activation due to some other disease process.

So, it's most correlated to vasoconstrictor waves, and is a very non-specific measure of autonomic activation and arousal. Assuming that they analyze the signal the way I think they do.

They did one of their first trials of the PAT at Stanford. I don't know if the data is still here.
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Postby somnonaut » Thu Feb 05, 2009 2:39 am

Very interesting.
So, LG what is your take on the recent pronouncements by Fisher&Paykel that they have PAP technology that can discern awake breaths from sleep breaths just by some measure of something in their systems?

http://www.sleepguide.com/profiles/blog ... and-fisher
http://www.fphcare.com/osa/pdf/OSA_HC_P ... lowres.pdf
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Postby linuxgeek » Thu Feb 05, 2009 5:16 am

somnonaut wrote:Very interesting.
So, LG what is your take on the recent pronouncements by Fisher&Paykel that they have PAP technology that can discern awake breaths from sleep breaths just by some measure of something in their systems?

http://www.sleepguide.com/profiles/blog ... and-fisher
http://www.fphcare.com/osa/pdf/OSA_HC_P ... lowres.pdf


I don't know that much about it, but it's based on Rapoport's patents.
Now, I could have it all wrong. It's one of those things I've been meaning to getting around to reading, so I won't really vouch for what I write (lol) but this is what I recall.

Their group submitted a couple of abstracts at APSS. If I remember correctly, they are looking at breathing variability/instability. And, I'm guessing that conscious breathing is more variable. They used a Neural Network to identify wakefulness, but it was unclear if F&P was actually using a Neural Net in the machine.

If this is correct, I would be most worried about confusing wakefulness with other periods that might be variable such as REM sleep. And, if it gets it wrong, lowering the pressure may not be what you want it to do.

It seems to be entirely something to improve adherence. If it can be shown to improve adherence overall, or for a select group, then I think it would be worthwhile.
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Postby ckoser » Thu Apr 30, 2009 6:44 pm

somnonaut wrote:I have boiled down my Accredited lab ability to perform HST to equipment such as:
Embla Embletta
Braebon Medibyte

And from there the other manufacturers (not that I have given it a total trial of every piece of equipment out there either) have things that I like or dislike.
There is:
Compumedics Somte
Grass Trek
Cadwell (never tried, not sure of name)
Clevemed Scout
Sandman Pocket
Respironics Stardust

All of these have varying numbers of PSG level parameter recording abilities, with either software to review and score second by second (Full disclosure), or allow for EDF to your present PSG system to score and report within one methodology.

I hope this helps.

I am sure I missed something it is early.



somnonaut,
Did you decide which system to get? Were all the systems comparable in price? We are looking at Compumedics, since that is the system that we use for our PSGs. What about them didn't you like?
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Postby somnonaut » Thu Apr 30, 2009 8:01 pm

Somte does NOT have dedicated temp airflow.
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Postby linuxgeek » Thu Apr 30, 2009 8:36 pm

somnonaut wrote:Somte does NOT have dedicated temp airflow.


But you can have a channel for that. Right?

Are you saying that there aren't enough channels to have all the other stuff you need for a PSG and the temp flow? I should know the answer to this question since we have a couple of Somte PSGs, but it's easier to just ask you.
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Postby somnonaut » Fri May 01, 2009 1:29 am

I guess you could plug an OTC temp flow sensor assembly into one of the EXG channels. http://www.compumedics.com/product_deta ... em=product
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Postby sleepyjim » Tue Jun 01, 2010 10:02 pm

Any new opinions?

"WatchPAT from Itamar Medical is included as an accepted ambulatory device for Medicare and Medicaid beneficiaries"

http://www.itamar-medical.com/Product.a ... &ppid=3006
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Postby HypnagogChick » Wed Jun 02, 2010 3:27 am

Awesome article, Rick!

Thanks! Nicki
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Postby linuxgeek » Mon Dec 20, 2010 7:36 pm

Watch-PAT questions answered here:

http://www.sleepreviewmag.com/expertins ... frmIndex=0

One of mine is answered on there, but the answer was not very satisfying. Some of the other ones I'm not sure the questions were well understood.
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Postby somnonaut » Mon Dec 20, 2010 10:06 pm

Oh goodie, lets see if they will post my question

In some of your answers you mention "Sleep Time" as if the device marks which Respiratory events happen in sleep time as is done during Polysomnography. But in reality is it not true that the Watchpat, as well as all other actigraphy based "sleep" recorders only give a total night sleep time approximation, and then arbitrarily conscript ALL respiratory events to this "sleep time" giving a false RDI (or AHI) since they do NOT specifically know which respiratory events actually OCURR during sleep? It could be said that one could fool the system by having fake respiratory events while awake half of the night, and then sleep soundly with no respiratory events for the remainder and derive from these "actigraphy" based devices a false RDI/AHI?
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