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Encore Pro Shows Cheynes Stokes Respiration in wave form
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Hmm888 Offline

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Post: #1
Encore Pro Shows Cheynes Stokes Respiration in wave form
Hello everyone,

I hope someone can shed some light on this for me.

My past CPAP machine never had this ability and my PSG template never had any indication Cheynes Stoke, but so far in the few nights of use, my Respironics Dreamstation shows Cheyne Stokes breathing.

Obviously, this is alarming. I will contact my DME and have him look at my data and make mention of this to my doctor too.

The interesting thing, software wise, Sleepyhead does not detect the Cheyne Stoke, however, I do know that the Resmed Airsense 10 numbers do show up in Sleepyhead. Perhaps it only shows up in "backend" of the app?

I have uploaded the waveform should anyone wish to try to analyze it.

Should I be concerned about the waveform anomaly?


Attached File(s)
.pdf  Pages from WaveFormReportPatient.pdf (Size: 424.89 KB / Downloads: 96)
04-17-2016 10:57 PM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
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Post: #2
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
(04-17-2016 10:57 PM)Hmm888 Wrote:  My past CPAP machine never had this ability and my PSG template never had any indication Cheynes Stoke, but so far in the few nights of use, my Respironics Dreamstation shows Cheyne Stokes breathing.
...
Should I be concerned about the waveform anomaly?

First, both snippets of the periodic breathing your machine flagged are relatively short (less than 5 or 6 minutes), and second, they do not look like classic Chenye Stokes breathing. Classic Chenye Stokes breathing is shown in this snippet of a PSG recording. The third graph from the bottom is the wave form data that is equivalent to what your DreamStation records.

[Image: june07-question.jpg]

As you can see, in real Cheyne Stokes breathing, the periodicity is pronounced as is the waxing and waning of the inhalations. There are a lot of things that the PR machines can flag as Periodic Breathing that are not Cheyne Stokes respiration.

In your case, it looks as though the flagged sections barely meet the criteria that PR uses to flag periodic breathing. I say that because there is not a particularly well defined waxing/waning pattern in the breathing. There are some hints of a pattern, but it's not well established.

It's not uncommon for the PR machines to flag some Periodic Breathing now and then. Since your machine is recording some most nights it's worth mentioning to your doc. But my guess is that s/he will tell you that as long as it's minor and looks like this, that you don't need to be worried about it.

Quote:The interesting thing, software wise, Sleepyhead does not detect the Cheyne Stoke, however, I do know that the Resmed Airsense 10 numbers do show up in Sleepyhead. Perhaps it only shows up in "backend" of the app?
SleepyHead reports the data that is recorded by the machine.

When viewing data from PR machines in SleepyHead, anything that the machine flags as Periodic Breathing shows up with a green background in the wave flow. And SH reports the % time in Periodic Breathing in the summary data. (If you need a screen shot, I'll supply one in a couple of days.)

The Resmed machines do not flag Periodic Breathing with a special code of any sort. They do record wave flow data, however. And if someone knows what they're looking for, they can scroll through the zoomed in Resmed wave flow data and identifiy likely periods of periodic breathing based on the shape of the wave flow. But because the Resmed machine's data does not contain a "flag" for Periodic Breathing, when Resmed wave flow is displayed in SH, there won't be a green background even on the most striking examples of clear Chenye Stokes breathing.

Questions about SleepyHead?
See my Guide to SleepyHead
04-18-2016 12:06 AM
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Hmm888 Offline

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Machine: Remstar Pro Legacy/AirSense 10
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Post: #3
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
Wow, much thanks robysue! That's so informative.

For some odd reason and perhaps I am confused, Sleepyhead isn't pickingup the Cheyne Stokes Respiration on my Respironics Dreamstation, perhaps it's a bug? However, it does show it from some Resmed machines. I have attached some images I found online:

[Image: bTltv2K.jpg]
and
[Image: jIW2w97.jpg]

I am curious, how were you able to determine from the wave form the period breathing was 5 or 6 minutes?
(This post was last modified: 04-18-2016 12:57 AM by Hmm888.)
04-18-2016 12:56 AM
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pupcamper Online

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Post: #4
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
(04-18-2016 12:56 AM)Hmm888 Wrote:  I am curious, how were you able to determine from the wave form the period breathing was 5 or 6 minutes?

Put your mouse pointer on an event in the events chart and it will display the duration of the event.

"....respiration,—a troublesome practice, but one which custom has rendered necessary to our easy existence...." Oliver Twist, Charles Dickens- 1837

I use FlashPAP to load data from a FlashAir III wifi sd card in my machine to my computer and display it with SleepyHead .
robysue's Beginner's Guide to SleepyHead
(This post was last modified: 04-18-2016 06:34 AM by pupcamper.)
04-18-2016 06:32 AM
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OpalRose Offline

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Post: #5
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
On the left side, above the pie chart, CSR is listed first in green shading. Click on that and a drop down box will appear showing the time in seconds of the event. That should correspond with the events graph on the right that is shaded in green.

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04-18-2016 07:24 AM
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robysue Offline
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Post: #6
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
(04-18-2016 12:56 AM)Hmm888 Wrote:  I am curious, how were you able to determine from the wave form the period breathing was 5 or 6 minutes?

Look at the time stamps at the left of each line of the wave form from Encore Pro. Each line corresponds to about a six minute window of breathing. Neither of the green flagged areas lasts for more than one full line of wave form data. Therefore each of the areas of flagged periodic breathing lasts less than 5 or 6 minutes.

Indeed we can get a pretty accurate estimate of the total time in PB by carefully examining each of the two sets of PB-flagged breathing. The first set of PB extends across a line break, but if you add the lengths of the two green areas together, it appears to be no more than 2/3 of a line long. Hence that set of PB lasts no more than 4 minutes (4 = 2/3 of 6). The second set of PB is just under 1/2 of one line. Hence it lasted just less than less than 3 minutes. So a more accurate estimate of the total time in PB is about 4+3 = 7. And that's an upper estimate of the total time in PB.


(04-18-2016 12:56 AM)Hmm888 Wrote:  For some odd reason and perhaps I am confused, Sleepyhead isn't pickingup the Cheyne Stokes Respiration on my Respironics Dreamstation, perhaps it's a bug?
Can you post a screen shot of SH's view of the same data that you posted in Encore? That's the only way we can see what you are talking about.

Questions about SleepyHead?
See my Guide to SleepyHead
04-18-2016 12:34 PM
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Hmm888 Offline

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Machine: Remstar Pro Legacy/AirSense 10
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Post: #7
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
(04-18-2016 12:34 PM)robysue Wrote:  Can you post a screen shot of SH's view of the same data that you posted in Encore? That's the only way we can see what you are talking about.

The info I have is pretty much the same as the one below (posted earlier) sample except the numbers et al and the name of the machine.

If you look under the date, you will see a separate line for Cheyne Stokes events (2.73%).

My Sleepyhead does not have Cheyne Stokes showing, yet Encore Pro does. I checked the preferences and it is ticked off there as the pic shows. I think this is a bug in the latest version of Sleepyhead.

[Image: bTltv2K.jpg]

Sample of my preferences:

[Image: lM1miBs.jpg]
04-18-2016 01:15 PM
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
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Post: #8
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
Hmm888,
On the screen that show the graphs, go to bottom of page, right side. You will see an events tab,
click on that, a drop down menu will appear. Choose CSR or it may be labled Periodic Breathing.

OpalRose
04-18-2016 01:31 PM
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robysue Offline
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Post: #9
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
Hmm888 you posted the following screen shot:

(04-18-2016 01:15 PM)Hmm888 Wrote:  [Image: bTltv2K.jpg]

Is this image from your data? If so, then SH is reporting the PB in the summary data on the green line labeled with Chenye-Stokes Respiration. Can you post a screen shot of the graphs, including the event table. There should be a green bar somewhere in the night's data that corresponds to the 2.73% time spent in Periodic Breathing listed in the summary data that you have shown.

The screen shot of your SH preferences shows them to be set up to show the Periodic Breathing flags.

Questions about SleepyHead?
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(This post was last modified: 04-18-2016 02:06 PM by robysue.)
04-18-2016 02:04 PM
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pupcamper Online

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Post: #10
RE: Encore Pro Shows Cheynes Stokes Respiration in wave form
This is a SleepyHead screenshot showing periodic breathing flagged on my data this morning.

[Image: Ms82ZTBt.png]

"....respiration,—a troublesome practice, but one which custom has rendered necessary to our easy existence...." Oliver Twist, Charles Dickens- 1837

I use FlashPAP to load data from a FlashAir III wifi sd card in my machine to my computer and display it with SleepyHead .
robysue's Beginner's Guide to SleepyHead
(This post was last modified: 04-18-2016 03:24 PM by pupcamper.)
04-18-2016 03:22 PM
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