Are pulse spikes like this generally normal at night?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
icipher
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Are pulse spikes like this generally normal at night?

Post by icipher » Sat May 30, 2015 7:27 am

Wore my monitor all night last night. The results show 114 pulse events.

Is this normal at night?

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SGearhart
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Re: Are pulse spikes like this generally normal at night?

Post by SGearhart » Sat May 30, 2015 7:43 am

Yes! What you're seeing is an artifact or outlier. They usually occur when you either bump the probe, turn over, or have rapid movement of the probe. Your chart looks very normal.

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HoseCrusher
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Re: Are pulse spikes like this generally normal at night?

Post by HoseCrusher » Sat May 30, 2015 12:22 pm

Oximeters try to keep track of the quality of the data they present. When a disruption in the data signal occurs it registers as an artifact. Conveniently the % of Artifacts is reported.

When I review your report I see 0.0% Artifacts.

No system is perfect but in general this means that Artifacts are probably not the issue and we have to look at little deeper.

The heart has variability in its beating rate until it is ready to stop beating. This variability is a good thing. However there is a difference between "normal" variability and stress induced changes. Simply measuring the beats per minute doesn't allow enough information by itself. More information is needed so how about adding in blood oxygen levels? Now you can look at the interaction between the two and come to a better conclusion.

The Analysis Parameters for Desaturation are reasonably straight forward, although there is some discussion if the drop on SpO2 should be 3% or 4%. I think the current thinking goes with a more liberal 4% drop. The default Analysis Parameters for a Pulse Event are pretty good if you are near death and want intervention to extend life a little longer. If you are somewhat healthy, and have a higher variability in heart rate, they give a lot of false signals.

You would have to discuss specific parameters with your cardiologist and I am under the impression that different conditions use different parameters. In general try adjusting the parameters to a change in rate by at least 15 beats per minute for a minimum duration of 30 seconds. This will still give a lot of false positives but will eliminate a lot of the "noise" generated with the default settings. My best guess is that running the 15 and 30 parameters you would see your pulse events lowered to around 15. From there you can zoom in on each event to see if there is any correlation between the pulse event and SpO2.

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JDS74
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Re: Are pulse spikes like this generally normal at night?

Post by JDS74 » Sun May 31, 2015 11:27 am

The tall, thin spikes are almost certainly artifacts of finger movement.

The other stuff may be normal for you or not.

For example, here is a set of heart rate graphs for me over time:
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On the March 30th graph, you can see a couple of those finger spikes. I looked at the raw data for those and what I saw was a dropt to zero, then the spike, then another drop to zero, and finally a return to good data. That is a pattern that happens when the oximeter loses signal - your finger moved, etc.

Now let's look at April 14th a year later.
Still some finger spikes but now we see real variability and some spikes that have a tapering off in the graph that follows.
The one of interest is at +1 01 on the graph. That's likely to be an arousal followed by falling back to a deeper stage of sleep. The mess at +1 00 on the graph is actual heart rate variability - didn't know the cause then.

On May 24th another year later, after I switched to a medical grade oximeter, we see only one of the finger spikes during the night at about 1:20 AM and another as I was taking everything off and getting up.
Same pattern for the 30th but no finger spikes except for that trailing one as I'm getting up.

Lots and lots of variability and real spikes distributed throughout the night.

My speculation is that the spikey stuff is a result of an endocrine condition that secretes periodically and the variability stuff is actual heart rate variability in my case, PACs.

I had a stress echo last fall in which they induced a heart rate of 120 BPM to check on what my heart was doing. The EKG report showed a gradual increase of rate from resting of about 65 BPM to a max of 123 BPM during the test.
However, I was also wearing my cms50f oximeter for the whole test and that same period showed a heart rate going from resting at about 65 BPM to a max of 153 BPM. On the report, it was noted "Frequent PACs". Their measure was from taped on electrodes and measured the heart directly. Mine was from the finger tip and measured indirectly from variation in blood density (when your heart beats, the volume of the capillaries increases and the fingertip device see an increase in blood density - more or less how it works.)

So, to concur with earlier posts, the finger spikey things are most likely just your hand moving and the sensor-oximeter loses track for a few seconds.

BTW, the sampling interval for the CMS50F devices is once per second.

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