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Hypopneas correlated with flow reduction?
#1
Hypopneas correlated with flow reduction?
I finally had a full night with the F30 with no leaks that I could detect, and slept pretty well. Got 2 smiley faces, and MyAir gave me a 100. But Oscar reported 3 hypopneas, which I found were correlated with a marked reduction in flow rate, just like the definition. My sleep MD wasn't concerned, but the Wiki article makes me wonder. Any opinions?

   
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#2
RE: Hypopneas correlated with flow reduction?
That's usually how it is on my charts with my Aircurve 10 vauto it usually responds fairly quickly to make sure more don't happen.
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#3
RE: Hypopneas correlated with flow reduction?
WTH, a constant PS of 8.6, your expirations are shorter than your inspiration. Despite your good numbers, what is going on?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#4
RE: Hypopneas correlated with flow reduction?
(05-26-2020, 08:40 PM)bonjour Wrote: WTH, a constant PS of 8.6, your expirations are shorter than your inspiration.  Despite your good numbers, what is going on?
Excellent question. Today's chart, with even more H events, goes off to my RT for comment.
   
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#5
RE: Hypopneas correlated with flow reduction?
You may need to zoom in to about 2 minutes on the events to show more breath detail for this RT to see it. It's out too far as is to show properly in my opinion.
Dave

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#6
RE: Hypopneas correlated with flow reduction?
The hypopnea events are periods of flow limitation, we would usually attribute to an airway restriction like chin-tucking. The highlighted periods of hypopnea appear to me as a low or absent spontaneous effort, and the machine is pacing your respiration. The respiration rate during these events is clearly lower, and the lack of spontaneous effort results in the appearance of flow limitation as the machine performs most of the work of respiration. This is likely related to your ALS rather than conventional flow restrictions or obstruction.

With this very high pressure support, there is not much we can do to further support inspiratory effort, so we have to look at mechanisms of obstruction that may be present. This second chart shows a normal inspiration/expiration time of 1.62/2.28 or a ratio of 1 to 1.4, In your case, I would still defer any judgement regarding respiration to your medical team. Overall, the event rate is very low, but with ALS I think backing up CPAP data with a pulse oximeter would be a good idea if there is any concern that a supplemental oxygen bleed should be added to the system.
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#7
RE: Hypopneas correlated with flow reduction?
(05-27-2020, 09:12 AM)Sleeprider Wrote: I think backing up CPAP data with a pulse oximeter would be a good idea if there is any concern that a supplemental oxygen bleed should be added to the system.

I'm using a soft cervical collar, so chin-tuck should not be a factor. I do have a Contec CMS50F which is somewhat of a PITA to use, but that's the next step, now that leaks are (hopefully) under control.
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#8
RE: Hypopneas correlated with flow reduction?
I hope I did not confuse you with regard to the flow limitations. With anyone else I would suspect obstruction, but in your case, these are periods where you are letting the machine do the work and set the pace. I do not think you need to consider a collar. If you get a periodic snapshot of where you stand in terms of SpO2 that will help in whether that issue should be escalated to your medical team. Your respiration rate, tidal volume and minute vent are all pretty good, so there is no reason to suspect you need supplemental oxygen unless the pulse oximeter shows otherwise. I think these periods of lower flow and respiration rate might be capable of resulting in a desaturation, and we just want to be sure to have a handle on that.
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#9
RE: Hypopneas correlated with flow reduction?
I've used the oximeter a few times in the past, but never saw anything of interest. Of course, then, the leaks were predominant, so the PAP data wasn't real valuable. No word back from the RT or ALS team yet, but a few days is normal. I have an all-hands team review on the 10th, so a comprehensive BiPAP discussion might be on the schedule. I'll try to use the oximeter tonight and get some fresh data.

Update: They want me to see a neuromuscular pulmonologist asap. In the case on neuromuscular pulmonologists, "asap" means "over a month", but they're going to try to sneak me in somehow.
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#10
RE: Hypopneas correlated with flow reduction?
I have said it before. The incredibly more intelligent ST-A with iVAPS is the machine you need. Please put it front and center for your All-Hands Meeting. I will be glad to help with the why you need it and how it's different and would provide better therapy.
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