Last night my son had a repeat diagnostic study followed by a MSLT today.  
Lab procedures have changed some and now require a cannula as well as a thermal strip to measure air flow.
HOWEVER, my son did not tolerate either.
How much is the sleep study going to be able to tell without the airflow info?

embryopathy wrote:

How much is the sleep study going to be able to tell without the airflow info?

Sleep fragmentation, EKG, and pulse. Probably not much else.

man...I wish I had thought to ask them about this at the time.
He did his 'funky' breathing that I always think looks like central apnea....I'm not sure if he had the thermal air flow strip in place at that time, or not.  (I didn't know it was missing till 5am; I know i saw the tech replace it around 1 am then I guess he gave up?).
So, IF his breathing is central apnea, could it show up from the chest/abdomen belts?

embryopathy wrote:

man...I wish I had thought to ask them about this at the time.
He did his 'funky' breathing that I always think looks like central apnea....I'm not sure if he had the thermal air flow strip in place at that time, or not.  (I didn't know it was missing till 5am; I know i saw the tech replace it around 1 am then I guess he gave up?).
So, IF his breathing is central apnea, could it show up from the chest/abdomen belts?

Well, the central apneas would be void of effort, so it is possible that it could be seen, however im not sure that a physician would be safe to diagnose it based on the belts alone.

RAM_Sleep wrote:

embryopathy wrote:

So, IF his breathing is central apnea, could it show up from the chest/abdomen belts?

Well, the central apneas would be void of effort, so it is possible that it could be seen, however im not sure that a physician would be safe to diagnose it based on the belts alone.

embryopathy wrote:

Lab procedures have changed some and now require a cannula as well as a thermal strip to measure air flow.

If these "new laboratory procedures" included the use of respiratory inductance plethysmography (which they should), then I think the physician would be quite comfortable not only scoring central apneas but differentiating obstructive events as well.  Events would be further supported by the presence of cortical /autonomic arousals and/or desaturations.

M.

Here's a nice PDF on the forms of respiratory plethysmography, if anyone is interested in following up on Morbius' comment:

http://www.ptservices.com/Downloads/Misc/pdf/RIP_Intro.pdf

Blessings,
--pseudonym

Morbius wrote:

If these "new laboratory procedures" included the use of respiratory inductance plethysmography (which they should), then I think the physician would be quite comfortable not only scoring central apneas but differentiating obstructive events as well.  Events would be further supported by the presence of cortical /autonomic arousals and/or desaturations.M.

The tech said another (don't know what to call it, procedure/technique/measurement) will be added next month...oh I remember, it's a CO2 measurement.  I commented that I would really like that and he said it is another cannula. (which my son will have nothing to do with, even w/the prongs trimmed down).

If Morbius is right, then flow monitors do not need used. Last I checked, the flow sensor was required.

The belts should be used only as a backup and only until the flow sensor can be fixed. It states so in the AASM scoring booklet.

Also, have you ever used these belts personally, or are you back to textbook descriptions again? There can be periods where the belts are unreliable.

No, the belts used w/my son were the type w/chrystals in only a 3-4" elastic part of the band.  I noticed the chest band had slipped downwards during the night and tried to move it up, but couldn't since he was laying on it.  The elastic part was underneath him (side-lying) at this time and the pdf above mentioned that it cannot function in this position.  By the time he got up the chest strap was basically on top, or at least immediately above, the abdomen strap.

Another thing, they sent him home after the 4th nap of the mslt, saying they had enough info.  He didn't sleep the first 2 naps, but I think he did the next 2.  The tech wouldn't tell me if he had rem or not.  is there one way that more commonly ends the test early, (a clue for me) or could it just as likely go either way?  I suspect he didn't have any.  I just hope so badly that something is going to show up w/this study!!

RAM_Sleep wrote:

If Morbius is right, then flow monitors do not need used. Last I checked, the flow sensor was required.

That wasn't the question.  The questions were

embryopathy wrote:

How much is the sleep study going to be able to tell without the airflow info?

and

embryopathy wrote:

IF his breathing is central apnea, could it show up from the chest/abdomen belts?

If the other signals were fairly clean using proper technology, the study should be quite effectively salvaged.  However, if

embryopathy wrote:

the belts used w/my son were the type w/chrystals in only a 3-4" elastic part of the band.  I noticed the chest band had slipped downwards during the night and tried to move it up, but couldn't since he was laying on it.  The elastic part was underneath him (side-lying) at this time and the pdf above mentioned that it cannot function in this position.  By the time he got up the chest strap was basically on top, or at least immediately above, the abdomen strap.

then we're starting to move away from "clean" signals.

Knowing the history of this case, it was pretty much a given that they would have to rely on effort alone and got the RIPs.

embryopathy wrote:

The tech said another (don't know what to call it, procedure/technique/measurement) will be added next month...oh I remember, it's a CO2 measurement.

That's a drag.  CO2 measurement is/has been a required standard for pediatrics (if they are, in fact, doing kids).  For a 24 year old, however, it would certainly be optional.  Unless you're tracking respiratory insufficiency, then we're back to necessary.

embryopathy wrote:

Another thing, they sent him home after the 4th nap of the mslt, saying they had enough info.  He didn't sleep the first 2 naps, but I think he did the next 2.  The tech wouldn't tell me if he had rem or not.  is there one way that more commonly ends the test early, (a clue for me) or could it just as likely go either way?

It could go either way.  If the sleep naps both had REM, then the test would be positive.  If neither sleep nap had REM, then the test would be negative regardless of the result of the 5th nap.  I think they should have done the 5th nap regardless.  But I tend to be a troublemaker.

RAM_Sleep wrote:

Also, have you ever used these belts personally, or are you back to textbook descriptions again?

That's really academic when you think about it, isn't it?

M.

M:  how do you define 'respiratory insufficiency'?  (isn't apnea insufficient respiration?)

the night tech did comment to me that the main thing he saw was noticably slow, shallow breathing.

re: the 5 naps...I think it was really because they were behind in their work....the night tech was pretty stressed about it, saying he was 2 hrs behind, and all the patients that night were little bitty's (2yr old and younger), except for my son.  I know 1 of them got so upset he threw up, and tech mentioned something about 2 severe patients.  (I had asked him if the abnormal breathing my son was doing at that time was showing up as apnea...He said he didn't have time to look at it ---because of above---but could look back later)...He never did though.  I know he was stressed coz when we first were hooking him up he commented that he was watching 2 kids and he should only have to be watching my son...that he complains about that all the time....then 1-2 hr later he was going back & forth to a copy room and stressing....Anyway, I digress....the day tech was discussing with his supervisor how many adult tests had to be scored, etc when I walked by (pacing the halls), then 10 min later walked in saying we were done.  When I questioned if he was sure about that, he said yes, his supervisor agreed.  so what could i do.  I clarified that means either he definitely had narcolepsy or defninetly didn't ---he said yeah.  I said, but I don't get to know which ?  he said , nope.

embryopathy wrote:

M:  how do you define 'respiratory insufficiency'?  (isn't apnea insufficient respiration?)

Respiratory insufficiency, or respiratory failure, occurs when the individual breaths are reduced in volume and/or the rate drops below normal, such that oxygen level drops and baseline pCO2 increases above the normal 45 mmHg.  This may be due to pulmonary or neuromuscular disease, severe CHF, drug overdose (like narcotics or barbiturates), stroke, etc.  The history of "hypotonia" and

embryopathy wrote:

the night tech did comment to me that the main thing he saw was noticably slow, shallow breathing.

would suggest at least taking a look at pCO2, whether by ABG, ETCO2, TcpCO2 or even indirectly looking at -HCO3 (part of routine electrolytes).

Say, what medications did he take, and what times did he take them during/around the MSLT?  Is he still on Zoloft?

BTW, that event you described back in the narcolepsy thread

http://www.apneasupport.org/viewtopic.php?p=115640

sounds more like an ALTE that any kind of narcolepsy phenomenon.  Mrs. RVW was right, that's a 911 Call if it happens again.

M.

ok now can you clarify all those types of CO2 measurements?


meds: only med taken in a.m. is miralax & mineral oil; zoloft, trazadone, ibuprofin, nasonex, astelin at 8pm the night before.

ABG = Arterial Blood Gas, the Gold Standard.  Blood taken directly from artery to measure pH, pCO2, pO2 and O2 Saturation.
ETCO2 = End Tidal Carbon Dioxide.  Nasal cannula samples exhaled gas on a breath-by-breath basis.
TcpCO2 = Transcutaneous Carbon Dioxide.  Sensor placed on chest or ear to record trends.
-HCO3 = Serum bicarbonate.  Venous blood sample.  You can estimate pCO2 using Henderson-Hasselbach Equation.

ALTE = Apparent Life Threatening Event.  Some combination of apnea, change in color, change in muscle tone, coughing, or gagging. Primarily occurs in children < 1 year.

embryopathy wrote:

....the day tech was discussing with his supervisor how many adult tests had to be scored, etc when I walked by (pacing the halls), then 10 min later walked in saying we were done.  When I questioned if he was sure about that, he said yes, his supervisor agreed.  so what could i do.  I clarified that means either he definitely had narcolepsy or defninetly didn't ---he said yeah.  I said, but I don't get to know which ?  he said , nope.

If it turns out that there was no REM, then you say, "Gee, do you think that the reason there was no REM in the naps was because he took Zoloft, a REM-suppressing drug, at 8:00 PM, and it has a half-life of 26 hours?!"

M.