Oximetry - WHAT???!!

[macewa]

My DME just did 4 oximetry tests on me. One with BiPap and Oxygen, One with BiPap Only, One with Oxygen Only and One with Nothing.

My highest pulse on BiPap with Oxygen was 250! How can that be? Low was 49 and my lowest Sp02 was 69%. BiPap with Oxygen was 79 desaturation events of less than 3 minutes and 3 events over 3 minutes duration.

On BiPap Only it was high pulse 85, my low pulse was 52 and lowest Sp02 was 81%. With BiPap Only I had 99 desaturation events of less than 3 minutes and 4 over 3 minutes.

On Oxygen Only it was high pulse 85, low pulse was 52 and lowest Sp02 was 82%. On Oxygen Only I had 75 desaturation events of less than 3 minutes and 2 over 3 minuites.

and on Nothing it was high pulse 92. Won't go into other details as it was very obvious I cannot sleep without anything.

What is that about? My BiPap Only and Oxygen Only results were almost identical. The Oxygen Only was a tad better.

I will have to go to the doctor to see what all of this means, but that high pulse of 250 scares me a lot!

EDIT: I wonder if they could have mixed up the tests? But they were done on different days so it would seem like they wouldn't have . . .

[archangle]

Ask the doctor, of course, but the 250 sounds like a glitch in the data.

[torontoCPAPguy]

I just love these quacks.

One night on oximetry during a sleep study does not make for a solid diagnosis except for a quack. Run like a bunny.

What you need is a run of empirical data; something that an S9 Auto would provide you along with a recording oximeter like the Contec CMS50E.

This is a topic that has been flogged to death on here and you need to to a search and read and educate yourself.

I discovered that I was best with the S9 Autoset and 4L/M of O2 into the airline. Kept me at 95% SpO2. I am now guessing that since my Atrial Fibrillation has now been brought under control and I am back in NSR I am running 100% SpO2 all night but need a whole month of that kind of data to make a determination without changing my APAP settings. I am about to do that but my guess, after educating myself, is that even with REM desats I am running 100% SpO2 all night and every night with O2 infused and I no longer require any O2.... we shall see.

You can readily see whay a single sleep study is not going to get you that information. Period. Not possible.

I intend to crank down the O2 and titrate my S9 Auto pressures once I am sure I am at 95% Sp)2 all night every night for a month and not a second before. How any sleep doc or respirologist could possible come to a conclusion based on a single night or partial night of data is beyong me. I am a scientist by training and anyone willing to do this to me is "quak" in my book and I am running away.

The other thing that needs to be checked out here is Atrial Fibrillation. At a pulse rate of 250, it is obviously not under control and it MUST be under control for any OSA data to be valid. It is a much tougher adversary than OSA but it MUST MUST MUST be addressed immediately. The best MD, the best hospital that deals with aFib in LARGE numbers successfully, etc., and then and only then can one deal with the OSA intelligently and with logic. Otherwise it is like a dog chasing its tail.

Good luck.

Murray L.

By the way, don't know where you are but you may want to visit the aFibbers board to find the best electrophysiologist/cardiologist in your area. Some are going to France to get the problem resolved. I am lucky in that I am near Southlake in Newmarket and they are one of the top 12 in the world.

[torontoCPAPguy]

One more thing.

Pulse rate of 250 may not be an anomoly at all. It sounds to me very much like Atrial Fibrillation or Atrial Flutter. THAT needs taking care of fast and before or at the same time as OSA although you will never get a solid handle on OSA until you at least acknowledge aFib in there somewhere so you can take it into account as well. It will desat your SpO2, race your pulse, and all the other nasties.

Get educated. Get it fixed by the best and don't mess with the rest. They can do damage.

[-tim]

Your blood pressure does increase while using CPAP. It should increase by about the same as the pressure (24 cm h2o (max for most cpap) is 17.6 mmHg but you won't see that much of an increase) . There is the slight chance that the O2 sensor was seeing what it thought was several pulse cycles when it only saw one. You could be reacting to the bipap and moving too much. You could have had a scratch on the finger they used for the SpO2 sensor. There are lots of ways to get bad info.

While I expect it was a false reading, I would do that test again. Next time, get one hooked up to an ekg or ecg machine while your doing the test. It measures your heart rate by watching the electrical activity while the pulse oximetry is only trying to guess your pulse by looking through your finger. The ekg machine should be able to alarm if your pulse is over something like 120 as it would be time to stop the test.

Also what is your o2 flow rates? The tend to be in the 2 to 15 liters/min with above 5 being somewhat rare.

[archangle]

One more thing.

Pulse rate of 250 may not be an anomoly at all. It sounds to me very much like Atrial Fibrillation or Atrial Flutter. THAT needs taking care of fast and before or at the same time as OSA although you will never get a solid handle on OSA until you at least acknowledge aFib in there somewhere so you can take it into account as well. It will desat your SpO2, race your pulse, and all the other nasties.

Get educated. Get it fixed by the best and don't mess with the rest. They can do damage.

As I said, do ask the doctor. If your pulse rate is really 250, that's a bad thing.

Was the test done with just a fingertip pulseox probe, or were there some electrodes stuck to you somewhere? I wonder if a pulseox would see an atrial fibrilation. It might not even see a real pulse rate of 250. It's sensing pressure and flow pulses way out at the other end of the circulatory system.

[jnk]

I'm not sure what the doc had in mind. Hopefully the doc knows what the doc had in mind.

It is likely that the comparison of the three other states to "nothing" was the entire point for the doc, in my opinion. It is possible that such comparative information could point a doc in a direction for further testing, even if the comparison itself, on its own, would do little as far as actual diagnosis or treatment decisions. Some data, cheaply obtained, is better than no data due to limitations on what some insurance payers are likely to pay for.

I think there is very little of use to you as a patient in those numbers, though. A "desaturation event" can be defined according to whatever parameters are set on the pulse-ox.

The highest pulse rate as reported, as has been said here already, can be thrown off with one or two little heart flippity-flips during the night that mean nothing, or next to nothing, in context, even if they did occur and aren't just measurement artifiacts of some sort. A home pulse-ox overnight says little or nothing in the context of actually diagnosing possible cardiac troubles, in my opinion as a fellow patient. It is important that we as patients don't get unhealthily concerned as we examine all the details of such test results, since every time we do, we add to the argument some docs make for hiding that info from us--it can cause us undue anxiety. At the same time, I think it is important for us as patients to keep records of those tests for ourselves--it can come in handy down the road. And I think it is great you are so involved. It is your body and you need to keep active in the decision-making process for your health, just as you are.

Personally, I would never fault a doc for gathering info, even very imperfect info, in a doc's attempts to be of help to me. That is a doc I would run to, not run from. It is true that if the doc attempts to misuse the imperfectly gathered data in a way that is not helpful to me, I would fight that. But if the doc understands the relative value of the info gathered and uses it properly, that doc may be an out-and-out genius thinking outside the box to find ways to be helpful as few docs manage to be on a regular basis.

Just sayin'.

Only my 2 cents.

[IndyDave]

The big question was how long was your pulse at 250? a couple of seconds, probably a glitch. Pulse oximeters are very sensative to any sort of movement. If it lasted a few minutes, definitely something to pursue. Also what was going on when it happened? Was your pulse normal just before, and did it return to normal quickly? It could have been a startle response to something that happened, or a momentary panic about getting enough breath.

And how long did he have you on each of these "trials" as he monitored or O2 sats? Time is important as it can take awhile for sustained oxygenation to occurr. Blood vessels expand and grow, the heart becomes more efficient, the lungs expand more...

I developed a sinus tachycardia a few weeks ago - my pulse is stuck at about 130 bpm, and so far they can't find a cause, and it doesn't respond to the couple meds they've tried. But because of that, I'm always stick on my fingertip pulse oximeter. My awake O2 sat has always been good - 88% or above most always. But I've been using my bipap for 2 months now, about 1 month since i got used to it. I have noticed that my my daytime saturations have been climbing, I'm rarely dropping below 95% for the past week.

[torontoCPAPguy]

The big question was how long was your pulse at 250? a couple of seconds, probably a glitch. Pulse oximeters are very sensative to any sort of movement. If it lasted a few minutes, definitely something to pursue. Also what was going on when it happened? Was your pulse normal just before, and did it return to normal quickly? It could have been a startle response to something that happened, or a momentary panic about getting enough breath.

And how long did he have you on each of these "trials" as he monitored or O2 sats? Time is important as it can take awhile for sustained oxygenation to occurr. Blood vessels expand and grow, the heart becomes more efficient, the lungs expand more...

I developed a sinus tachycardia a few weeks ago - my pulse is stuck at about 130 bpm, and so far they can't find a cause, and it doesn't respond to the couple meds they've tried. But because of that, I'm always stick on my fingertip pulse oximeter. My awake O2 sat has always been good - 88% or above most always. But I've been using my bipap for 2 months now, about 1 month since i got used to it. I have noticed that my my daytime saturations have been climbing, I'm rarely dropping below 95% for the past week.

IndyDave: You are absolutely right; pulse at 250 for only a couple of seconds is almost certianly an anomoly caused by an outside factor; however, pulse rate lasting a few minutes at 250 bpm is certainly worth further investigation and the BEST way to do that is get a ECG right away; the latest ECG's will actually diagnose Atrial Fibrillation.... let alone tachycardia at 250 bpm read from the heart. Unlikely to be a startle response at that rate for sure.

Don't know where you got this business about it taking a while for sustained oxygenation to occur... my experience has always been that just a few deep breaths will bring my SpO2 up to 95-99% in seconds. During the day, while you are in motion, your SpO2 SHOULD BE in the 90's, generally in the mid 90's.Blood vessels do indeed grow as do chambers of the heart. This is referred to as "remodelling" and is NOT a good thing. Enlargement of the heart chamber(s) due to tachycardia, atrial fibrillation or whatever is a very bad thing. It causes the heart to work less efficiently and leads to heart failure. The blood vessels will not grow and the heart will not become more efficient in a matter of hours. It takes quite a long time for this sort of remodelling to take place.

Tachycardia at 250 bpm is cause for concern to be sure. A constant pulse rate of 120-130 bpm is cause for concern. No question here. If drugs being administered are not correcting the problem then you need to find a cardiologist/electrophysiologist who is very experienced and in a cutting edge facility and you need to do it sooner than later.

Please, for your own sake, you do not want to poo-poo any of these symptoms, especially arrhythmias or tachycardia. Your heart will remodel by expanding the atria, or worse, the ventricals. Enlarged atria are very bad news... generally the larger the chambers, the less efficient your heart will be working and the less oxygenated blood your heart will be pumping through your system. You are at this point suffering from congestive heart failure (not a death sentence but a condition that requires immediate and drastic attention and treatment).

I can say, without any hesitation, that the data that your pulse oximeter is going to give you is well worth recording and printing out; if nothing else it is going to get you fast tracked.

Your SpO2 when active during the day should be over 90% without hesitation. At night, when at rest and breathing shallow, it must still remain above 89% - remember that anything under 89% is considered respiratory distress. If it is dropping below 89% it certainly means, cardiac ineficiency (aFib? CHF?), apnea related desats, lungs innefficiencies, you name it.

The thing I want to reiterate is that you need to sort the wheat from the chaff on this board in terms of opinions and advice and get some strong, experienced, expert medical advice. It's not easy to find at times. My first cardiologist was an idiot and by the time I found MY expert, my left atrium was already at 60mm. (too big for even a catheter ablation surgery). I was essentially quality of life = 0 and I was fortunate to be accepted into the TIKOSYN program which put me back into Normal Sinus Rhythm where I have remained since December; at my July recall we are hoping that my left atrium has shrunk substantially. My aFib is under contol, my OSA is under control, my SpO2 at rest (REM) with damaged lungs due to acute pneumonia and life support three years ago this week is under contro.... we are on the road to getting 'fixed'.

Got lots of good advice on this board and on the aFibbers board as well (where there is a much higher level of experience and knowledge) and on the Sleep Apnea board as well. I have read every white paper published in the last ten years on these topics. Trust me when I say (a) I have the T shirt and (b) find yourself a top notch doc. Oh. And take what you read on here with a grain of salt. You can't tell the BS from the quality advice and you MUST MUST MUST educate yourself and advocate for yourself.

God Bless and Good luck.

[jnk]

. . . a few minutes at 250 bpm is certainly worth further investigation . . .

I agree.

. . . One night on oximetry during a sleep study does not make for a solid diagnosis . . .

I agree.

I also agree with the following:

. . . It's fairly common to feel your heart flutter, flip-flop, or skip a beat from time to time. If you monitor the heart rhythm of any person long enough, almost everyone will display the occasional skipped or extra beat. . . . "The vast majority of arrhythmias are benign," says Gordon F. Tomaselli, MD, professor of medicine at Johns Hopkins University School of Medicine in Baltimore. But that doesn't mean you should ignore arrhythmias. Some arrhythmias raise the risk of a stroke, heart failure, and sudden death. So it’s prudent to alert a doctor about any erratic beats (especially if new or frequent) -- even in the absence of bothersome symptoms. . . .

http://www.webmd.com/heart-disease/feat ... s-debunked

[-tim]

I've been playing with my resmed s9's SpO2 toy again and it hit 265. That was right after I put it on:

[macewa]

This was done with a finger thingie. My blood pressure is anywhere from 112-125 over something in the 50s or 60s. If anything my lower number gets too low. Since weight loss I went off blood pressure meds. Possibly tomorrow I can get in to see my PA and see what she thinks. I've had so many tests done this year and everything comes back great - sooooo ??

One more thing.

Pulse rate of 250 may not be an anomoly at all. It sounds to me very much like Atrial Fibrillation or Atrial Flutter. THAT needs taking care of fast and before or at the same time as OSA although you will never get a solid handle on OSA until you at least acknowledge aFib in there somewhere so you can take it into account as well. It will desat your SpO2, race your pulse, and all the other nasties.

Get educated. Get it fixed by the best and don't mess with the rest. They can do damage.

As I said, do ask the doctor. If your pulse rate is really 250, that's a bad thing.

Was the test done with just a fingertip pulseox probe, or were there some electrodes stuck to you somewhere? I wonder if a pulseox would see an atrial fibrilation. It might not even see a real pulse rate of 250. It's sensing pressure and flow pulses way out at the other end of the circulatory system.

[archangle]

This was done with a finger thingie. My blood pressure is anywhere from 112-125 over something in the 50s or 60s. If anything my lower number gets too low. Since weight loss I went off blood pressure meds. Possibly tomorrow I can get in to see my PA and see what she thinks. I've had so many tests done this year and everything comes back great - sooooo ??

Was there some sort of graph or just a max pulse number?

If there's a graph, you can often spot glitches. Unfortunately, these gadgets often need someone who knows what they're doing to read and filter out the invalid readings.

[macewa]

No, there wasn't a graph, just numbers. I will check into it, but for once in my life, I'm not going to panic. I've had so many things done this year that surely if I had a serious problem, something would have shown up during some of those processes. And most of my arteries have been checked and are clear (which I thought was good news). The person at my DME was just trying to gather info for me prior to my doing another sleep study. This was during a time period where I was having so much freaking pain with head gear and masks that I couldn't get a real reading most of the time on my AHI. I will go back in and talk with her about this particular event. To my knowledge, I have never had a fast pulse. Actually finding it is usually a problem.

What I do know is that I must use the mask/machine and the oxygen at night. And I must take my Ritalin during the day. When I do those things, my life is somewhat manageable -- at least I've been able to hold down my part time jobs for two months now. The last one I lost in 3 weeks due to falling asleep on the job. (using my machine/mask). Progress

thanks for you comment and to others that commented. I'm not ignoring what you've said. I'm just not panicking over any of it.

This was done with a finger thingie. My blood pressure is anywhere from 112-125 over something in the 50s or 60s. If anything my lower number gets too low. Since weight loss I went off blood pressure meds. Possibly tomorrow I can get in to see my PA and see what she thinks. I've had so many tests done this year and everything comes back great - sooooo ??

Was there some sort of graph or just a max pulse number?

If there's a graph, you can often spot glitches. Unfortunately, these gadgets often need someone who knows what they're doing to read and filter out the invalid readings.