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Shin Ryoku
Unread post  Post subject: Ref for learning how to tell Sleepyhead events are correct?  |  Posted: Tue Dec 19, 2017 8:21 pm
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Is there an online reference that teaches someone how to read sleep studies? I'd like to be able to look at something like this:

Image


And tell if Sleepyhead basically scored the events correctly as hypopneas and apneas (assuming that I know I was asleep and that there is O2 sat data to support).

Does anyone know of any good references?


I am a physician and was thinking about buying this book: https://www.amazon.com/Principles-Pract ... p+medicine

But I don't want to spend $200 if it isn't going to have the information I need.

Thanks,
Amin


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Pugsy
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Tue Dec 19, 2017 9:52 pm

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SleepyHead doesn't do the scoring or flagging or the interpretation of those events.
The cpap/apap/bilevel machine does the scoring and the naming and the flagging. SleepyHead only reports what the machine reports/records.

If there is an accuracy question for something weird shown on SH I usually suggest verifying with the name brand manufacture software.
Like ResScan if using a ResMed machine. I have never had SH report anything that wasn't also showing up on the ResScan report when it comes to flagged apnea events. Only thing different might be a number slightly different due to rounding up or rounding down since the machines and ResScan go to 1 decimal point and SleepyHead goes to 2 decimal points.

Now as to how the ResMed machine reports anything in terms of accuracy...I don't have any way to verify that. There is certain criteria for each flagged event before the machine will create a flag. So the machine thinks something happened to earn a flag.
OAs or centrals are fairly easy to spot because they require at least an 80% reduction in air flow for at least 10 seconds. Hyponeas are a little harder to spot the reduction in air flow sometimes if the reduction isn't so blatant. Like if the reduction is 40% and last 10 seconds and it gets a hyponea flag. Everything has to have a duration of at least 10 seconds to earn a flag. Sometimes hyponeas are a little harder to spot.
Then there are the full grown reduction in air flow that last only 9 seconds...they don't get a flag because they didn't last 10 seconds.

So the software (whatever you use) is going to report whatever the machine records...no more and no less. Now is the machine 100% spot on accurate all the time??? Since awake breathing can sometimes fool the machine it might not be 100% but it's probably very close.

I have no idea how thorough that high dollar book might be.


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Shin Ryoku
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Wed Dec 20, 2017 5:06 am
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Thanks, Pugsy. It's good to know that Sleepyhead and ResMed report the same events.

I was watching one of Jason's videos, where he was commenting on some of the autoscored data from a home sleep apnea test and pointing out certain areas where he could see visually the machine had scored an event incorrectly. I'd like to learn how to do that.


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Pugsy
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Wed Dec 20, 2017 7:55 am

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Jason is a sleep tech so he was trained in it and has seen lots of flow rate to have the experience needed to interpret flow rate.
I can do it a little bit and only if the flow rate is fairly obvious and it took me years of research and looking at flow rate to get comfortable with my abilities. At least now I am semi comfortable with what awake breathing air flow looks like and what arousal breathing looks like. Telling central and obstructive apart..that's still a work in progress.

I have long searched for something that I could read and see and it would explain the minute differences in flow rate that makes up whatever might get called. I haven't found it. I have no idea if that high dollar book will have that sort of stuff or not. For me and my curiosity spending money just to learn more minute details is not in the cards nor is it really needed so I haven't gone there.

Now if I lived near Jason where I could go in person and spend the day and have him actually show me the minute differences so I could have it explained....in a heart beat. I would love to learn more but as it is now I have to accept my limitations and if I have a question about something then I send him a message and ask him if what I am seeing is what I think I am seeing.


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TheLankyLefty
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Wed Dec 20, 2017 8:42 pm
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Hey Amin!

I don't know many Amin's so I'm assuming you are THE Amin. ;)

That look like just a typical arousal with movement after it. The arousal being 3:29:10. After this it all appears to just be settling.

I would be an hours wage that after the arousal time there is little, if any, sleep.

I'm kicking around the idea of publishing a book. This kind of thing I think would be very helpful and was absolutely a "chapter" that I wanted to spend some time on.

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Shin Ryoku
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Thu Dec 21, 2017 12:09 pm
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Hi Jason! Yes, I'm THE Amin :). Hmmm, that's very interesting. I wish there were an affordable home test to tell us whether we were asleep at any given time!


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Shin Ryoku
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Wed Dec 27, 2017 7:42 am
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Please have a look at the two machine-scored OAs indicated by the red arrows below:

Image

Image


Am I right that those are both preceded by likely arousals?

The AASM Scoring Manual FAQ says that events following arousal are still valid if they otherwise meet the criteria. So in terms of deciding whether the above are real OAs, am I right that the main question is whether I was asleep?


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TheLankyLefty
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Wed Dec 27, 2017 1:17 pm
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Shin Ryoku wrote:
Am I right that those are both preceded by likely arousals?
Yes. I would agree that both are high likelihood of being arousals prior to the event.

I would also bet that both (if respiratory belts were present) are really Central.

Shin Ryoku wrote:
The AASM Scoring Manual FAQ says that events following arousal are still valid if they otherwise meet the criteria. So in terms of deciding whether the above are real OAs, am I right that the main question is whether I was asleep?
This is such a great comment. You are correct that this is what the AASM says. When I am taking the AASM Interscorer Reliability Tests I score according to this method (and it hurts my soul).

I don't know why the AASM has the rule this way. All Sleep Specialists I've worked with in the past and present don't want us to score these "in the real world" for their patients. The reasoning is that they are seen in all patients post arousal. For that reason they are considered normal. If they are normal, then they don't want them included in the AHI that is going to be used to make a diagnosis. To me this makes a great deal of sense.

In the first example it looks like you immediately go back to sleep. The second example it appears that you stay awake.

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Shin Ryoku
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Wed Dec 27, 2017 9:25 pm
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TheLankyLefty wrote:
All Sleep Specialists I've worked with in the past and present don't want us to score these "in the real world" for their patients. The reasoning is that they are seen in all patients post arousal.



That's very interesting! The studies I found that looked sleep in normal, young, healthy people showed zero or near-zero apnea indexes in most. Eg:

https://academic.oup.com/sleep/article- ... 060203.pdf

So either those young healthy folks weren't having arousals, or they weren't scoring post-arousal events, or post-arousal events aren't really normal for the young healthy. I'm definitely interested to learn more about this.


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Shin Ryoku
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Thu Dec 28, 2017 11:35 am
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TheLankyLefty wrote:
I would also bet that both (if respiratory belts were present) are really Central.


Can I ask why you say that? Is it because there is no apparent flattening of the inspiratory flow?

I'm starting to second guess my SleepyHead results a lot. It's making me wonder if I even have OSA :oops: . I guess I'll know pretty soon if I slept enough for the home test to be usable.

In the meanwhile, out of curiosity, I slept last night with a full face mask (Simplus) at much lower than my usual pressures and got the following:

Image

Image

Image

Image


Leaks aside, those examples look like true positives, right? The previous examples in the other posts were when I was using higher pressures (Minimum EPAP of 17).

Tonight I'm going to try the full face mask with CPAP 4 and see what I get :) .


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TheLankyLefty
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Thu Dec 28, 2017 10:43 pm
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Shin Ryoku wrote:
So either those young healthy folks weren't having arousals, or they weren't scoring post-arousal events, or post-arousal events aren't really normal for the young healthy. I'm definitely interested to learn more about this.
I would think that they aren't scoring post arousal events. To my knowledge, nobody scores these. I took part in a Stanford CPAP Efficacy study (as a scorer) and was instructed to not score post arousal central apneas. A post arousal central being a central after an arousal where the subject falls back to sleep immediately after the arousal and resumes thoracic, abdominal efforts as well as nasal airflow.

Shin Ryoku wrote:
Leaks aside, those examples look like true positives, right?
Absolutely. Those examples look like clear OSA. The leak is actually fine during this segment. It does suggest mouth/mask sputters though.
Shin Ryoku wrote:
TheLankyLefty wrote:
I would also bet that both (if respiratory belts were present) are really Central.


Shin Ryoku wrote:
Can I ask why you say that? Is it because there is no apparent flattening of the inspiratory flow?
In that example I think that there is a cessation in inspiratory flow. There are little "blips", but those aren't breaths. What I'm mostly going by is what comes after. The first example is the best of a post arousal central. Arousal, with cessation of airflow, followed by "normal breathing." If it were an OSA, you would see airflow decreasing like you do in the most recent examples that you posted followed by a much larger (compared to "baseline") inspiration once breathing resumes.

Shin Ryoku wrote:
I guess I'll know pretty soon if I slept enough for the home test to be usable.
:)

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Shin Ryoku
Unread post  Post subject: Re: Ref for learning how to tell Sleepyhead events are corre  |  Posted: Fri Dec 29, 2017 5:33 am
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Thanks, Jason. Very much appreciated.

So I went ahead with my CPAP 4 experiment last night (Simplus again b/c I cannot tolerate nasal PAP at such low pressures) and got this:

Image

Image

Image


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