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Odd UA Events I've Never Seen Before
#1
Odd UA Events I've Never Seen Before
These are really odd UA events logged last night.  I can't figure out what they are.  The Therapy Pressure is high and constant, Mask pressure looks as if I was breathing yet Flow Rate is close to none.  All while Leak Rate and Flow Limit both logged 0. Rest Rate recorded at or near zero which corroborates Mask Pressure.  I can't figure this out. Huhsign  Could it be I had somehow blocked the exhaust vents for a short period of time?  I can't convince myself of that though, because I did have several breaths logged between similar events.  Any ideas?  Is this some sort of oddity that I should not be too concerned about?

Ray

       
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#2
RE: Odd UA Events I've Never Seen Before
G'day Ray. These look like obstructive apnea to me. As you know the Resmed ASV doesn't distinguish between obstructive and central apneas but just reports all of them as UA. The Resmed literature also states that central apneas are completely eliminated and we should treat all apneas as obstructive. You can see that the mask pressure is going up to get some airflow going, and there is in fact a tiny bit of flow happening, but negligible. Then suddenly there is a big recovery breath - a gasp for air. This is typical of obstructive apneas in my experience.
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#3
RE: Odd UA Events I've Never Seen Before
Your ASV is trying to kick start your breathing by giving a boost of air you can see the pressure increases in the the mask pressure line but it is failing to get you to take a breath, as these are in clusters it could be positional, do you use a soft cervical collar ? Have you tried one ?
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#4
RE: Odd UA Events I've Never Seen Before
I too think they are obstructive. Could be positional with chin tucking during REM because of the spacing between clusters, 90m-2hr? The 20cm pressure didn't clear the obstruction, so there may be more than a normal apnea. I'd also check for mask air defusing under the seal, even though there are no leaks shown. try the mask fit setting, that blows high pressure.
I would have
min epap 9
max epap 15
min ps 3
max ps 15
Then review. I think opening up the machine max pressures, may give a better picture.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#5
RE: Odd UA Events I've Never Seen Before
I started to respond yesterday to the same effect: obstructive. among other things I thought the little bumps were evidence of respiratory effort but then I saw a thread in which Crimson Nape posted a flow of FOT machine generated pulses that looked similar, maybe more uniform than RayBee's but similar enough to be confusing. there must be a place to go to see examples of obstructive vs central flows. anyone have a link handy? or willing to explain how to distinguish between them?
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#6
RE: Odd UA Events I've Never Seen Before
I would increase the max PS to 15 and see if your ASV can blow through these events, the ASV will only use as much pressure as it needs
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#7
RE: Odd UA Events I've Never Seen Before
(04-07-2019, 12:53 PM)sheepless Wrote: I started to respond yesterday to the same effect: obstructive.  among other things I thought the little bumps were evidence of respiratory effort but then I saw a thread in which Crimson Nape posted a flow of FOT machine generated pulses that looked similar, maybe more uniform than RayBee's but similar enough to be confusing.  there must be a place to go to see examples of obstructive vs central flows.  anyone have a link handy? or willing to explain how to distinguish between them?
If there isn't already, there will be.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#8
RE: Odd UA Events I've Never Seen Before
(04-07-2019, 03:54 PM)bonjour Wrote:
(04-07-2019, 12:53 PM)sheepless Wrote: I started to respond yesterday to the same effect: obstructive.  among other things I thought the little bumps were evidence of respiratory effort but then I saw a thread in which Crimson Nape posted a flow of FOT machine generated pulses that looked similar, maybe more uniform than RayBee's but similar enough to be confusing.  there must be a place to go to see examples of obstructive vs central flows.  anyone have a link handy? or willing to explain how to distinguish between them?
If there isn't already, there will be.

That's a great idea.

Fred, feel free to use these if they can be of any service in an "example" library.  These CA's were recorded on a VAuto on my titration study #5.  Study #6 was with the ASV machine.  I turned off some of the graphs that seemed to me to be of lesser value and/or contained no data.  The good, the bad and the ugly.  Well, ok, they are all ugly.

Ray

[attachment=11177][attachment=11178][attachment=11179][attachment=11180][attachment=11181]
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#9
RE: Odd UA Events I've Never Seen Before
(04-07-2019, 12:53 PM)sheepless Wrote: I started to respond yesterday to the same effect: obstructive.  among other things I thought the little bumps were evidence of respiratory effort but then I saw a thread in which Crimson Nape posted a flow of FOT machine generated pulses that looked similar, maybe more uniform than RayBee's but similar enough to be confusing.  there must be a place to go to see examples of obstructive vs central flows.  anyone have a link handy? or willing to explain how to distinguish between them?

I think the little bumps in the flow chart is just the asv banging with 20cm and getting nowhere. The ASV doesn't have FOT.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#10
RE: Odd UA Events I've Never Seen Before
well of course. I actually knew that asv doesn't pulse but didn't put it together. still uncertain though: does the "asv banging with 20cm" suggest the bumps are from machine pressure, even if not FOT, or evidence of respiratory effort? or both?
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