breathing query

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breathing query

Postby picklish » Thu Apr 27, 2017 9:50 am

Annoying HSAT so no arousals available, but what do you think?

Large breath followed by series of small breaths. Only a couple of desaturations (one more hypoponeas should be scored) but regarding the other events, do you see this pattern often? We don't score RERAs here generally, but it's not my impression that this is what a RERA would be, even if we could see arousals. The big breaths coincide with increased effort, but only for the duration of one breath.

Subclinical events? Are those small breaths a drop in peak signal excursion by ≥90% of pre-event baseline?

Am I missing something obvious here?
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Re: breathing query

Postby somnonaut » Thu Apr 27, 2017 12:06 pm

Ahhh the vagaries of HST.
But my interest is piqued by your statement "...not my impression that this is what a RERA would be, even if we could see arousals." This is EXACTLY what RERA COULDlook like, BUT is also what PLMS could look like. The real question is the size of the "SNORES." Too bad the blue bars are not sized per snore level, then we could sense crescendoing snores terminating with a large one at the resumptive breath (Hyperpnea.) There is the choppy Flow signal during the Hypopneic phase though, so you got that going for RERA.
But alas, the diff Dx cannot be rendered without PSG.
What system is this being scored on?
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Re: breathing query

Postby picklish » Thu Apr 27, 2017 12:54 pm

Stardust is the system

Ahh, I see that I misread an 'and' for the 'or' in the following statement from the manual: "RERA.....characterized by increasing respiratory effort or by flattening of the inspiratory portion of the nasal pressure"

I thought of RERAs as a being more like a smaller flow limitation (i.e. <30%) with an arousal, not quite enough to be a Hypopnea, but a respiratory-related arousal nonetheless

I measured the differences in excursion between the large breaths and smaller ones, and the small breaths are around 80-85% smaller. - very close to obstructive apnoeas, but not quite. This doesn't seem to me to be what is meant by the manual as RERA, but perhaps I am getting the wrong idea about them - it's the flattening that's important, not the size of breath?
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Re: breathing query

Postby somnonaut » Thu Apr 27, 2017 9:53 pm

What! You "misread" the most poorly worded manual? You MUST be joking. (J/K) I "misread" that thing every day.
Unfortunately, without arousals you are dead in the water. Since, the pressure cannula signal is the WORST at reproducibility, the way most use it as you speak, as a global envelope change.
There is some more information in your tracings though, the little notch in the effort tracings hints further at respiratory based issues versus PLMS. Think what it would take to produce that notch. A full reversal of the movement of the belt. Now being the effort tracings is out of phase to the airflow, I am not sure which is correct for inspiration (up) versus expiration (down), the belt or the airflow? If we assume the belt, then the notch is during the expiratory phase and not much should be read into it, but if the belt is out of phase, then it is during the inspiration, and that would imply a good amount of resistive breathing during inspiration.
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Re: breathing query

Postby somnonaut » Thu Apr 27, 2017 11:28 pm

Here is an interesting image from Somnoscreen HD brochure.

http://somnomedics-diagnostics.com/file ... _11_21.pdf
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Re: breathing query

Postby RayMeece » Mon Jun 12, 2017 4:03 am

ahh, the inherent limitations of the noble HST. Your only options are apnea, or hypopnea, so with no Desat, hypopnea is out. doesn't really look like apnea either, so no event, except the one that is scored with a desat.
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