PLMs between Resp events

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Re: PLMs between Resp events

Postby RayMeece » Wed Aug 09, 2017 3:36 am

wow. methinks you think too much. LOL

here's the way I see it, down to the nuts and bolts:

An arousal is not, technically, an "event". It is more of a marker of transition from sleep to a lighter stage, or to wake. After an arousal(whether 3 sec or 28 sec, or whatever), the epoch is scored as whatever stage is appropriate for that epoch.

You DO have an arousal leading to wake, because that is the transition. And the arousals get counted in the PSG report, which leads to your statement that "arousal is where it is at".

You are on the ISR panel correct? Now I see why there is such discord in the scoring. If you would just take the manual for what it says, and quit trying to outhink it, it would be much simpler.

I don't understand why you make it so hard.
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Re: PLMs between Resp events

Postby somnonaut » Wed Aug 09, 2017 10:23 pm

It is very simple actually:

If arousal = wake
Then there must be a defined offset so the arousal time can be added to WASO

If arousal ≠ wake
Then this new state of being should have an offset so it can be reported adequately.

You should put more thought into what you claim you do. Automatic behavior does not a scorer make.

In my opinion arousals ARE the most important aspect to a PSG. Their etiology should be sourced and their impact assessed by knowing how long each lasts. A simple count is not adequate. Also, each arousal does NOT lead to a stage change.
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Re: PLMs between Resp events

Postby StuKing » Thu Aug 10, 2017 1:06 am

Just gonna put this here.

AASM Scoring Manual v2.4, Section V - Scoring Arousals.
Note 5: An arousal may still be scored if it immediately precedes a transition to stage W. That is, both the arousal and transition to wake are scored.

Grabs popcorn
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Re: PLMs between Resp events

Postby somnonaut » Fri Aug 11, 2017 4:31 am

Yeah yeah, that is the "out" to just put these markers (arousals) all over the place.

I would have min 3 sec, max 28 sec and new marker (placed with no time construct) for "arousals" that lead to awakening. Of course this new marker would be called "awakening" So, tabulation would be across the other physiological events (Resp PLMs) describing the arousal types and cumulative arousal time for each. This way we can better source the disruption.
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Re: PLMs between Resp events

Postby somnonaut » Fri Aug 11, 2017 4:32 am

Steals popcorn
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Re: PLMs between Resp events

Postby somnonaut » Fri Aug 11, 2017 4:39 am

BTW, there are other needs within the arousal scoring rules that scream for clarification.
What constitutes "stable sleep" prior to an arousal? Does there have to be no trace of alpha< or fast activity, for the 10 seconds before an event?
What constitutes "abrupt shift?" How fast (change over time?) This plays into the "stable sleep" issue above.
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Re: PLMs between Resp events

Postby RayMeece » Mon Aug 14, 2017 3:47 am

Claude, I guess you just need to make sure you are on the AASM Scoring Manual ver 3.0 committee

Good luck on that!! haha
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Re: PLMs between Resp events

Postby RayMeece » Mon Aug 14, 2017 3:50 am

But, really, I see where you are coming from, that arousals matter. And IMHO, the more-important thing is what causes the arousal. You cannot fix an "arousal", but you can fix the cause (or at least attempt to). That is why I think you are over-thinking this issue.
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Re: PLMs between Resp events

Postby somnonaut » Mon Aug 14, 2017 1:45 pm

BTW, I am on that committee as well. Was appointed at the APSS meeting. Here is more proof of need. The manual itself mentions END of event (arousal,) but never defines it. Where is the offset? What governs the termination of an arousal? Return to pre-event EEG pattern? Change from event EEG pattern but not requiring back to baseline? Are there different rules for different arousal types (more than likely)...which is the point exactly. You cannot report correctly that which you do not measure.
There obviously is the expectation of arousals having a terminus.
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Re: PLMs between Resp events

Postby RayMeece » Tue Aug 15, 2017 3:43 am

somnonaut wrote:BTW, I am on that committee as well. Was appointed at the APSS meeting.


Oh Lawd - look out for version 3.0!!!
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