Oximeter .... how do I use this information?

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SleepWrangler
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Oximeter .... how do I use this information?

Post by SleepWrangler » Sat Apr 19, 2014 6:20 am

I've worn a CMS-50F for a couple of nights. I assume time will tell me if the SpO2 and PR indices somewhat track AHI and how closely the events correspond. Overall I desaturate <88% very briefly. Not certain how to use this information or what to highlight for the sleep doctor. I doubt she will sit still to review pages of logs so I want to optimize my time with her. Advice is welcome.

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JDS74
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Re: Oximeter .... how do I use this information?

Post by JDS74 » Sat Apr 19, 2014 8:20 am

SleepWeangler

Just bring this report to your doctor.
She will note that almost all of your SpO2 readings are above 90% and you"'ll get an "Atta-boy, good numbers."
The one dip is for such a short time as to be of no concern.

Your artifact% is also very low so moving around at night is not a problem for your numbers.

Cheers

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HoseCrusher
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Re: Oximeter .... how do I use this information?

Post by HoseCrusher » Sat Apr 19, 2014 10:17 am

I agree.

Your 1 event at roughly 4:40a is the pattern you want to avoid. As your O2 saturation fell off your heart rate increased and spiked. If you see a whole bunch of these you need to make some adjustments.

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Re: Oximeter .... how do I use this information?

Post by pbriggs » Sun Apr 20, 2014 7:41 am

I transfer the data into excel and graph my readings based on median values for both pulse rate (BPM) and SpO2 (% saturation). I also import the data into sleepyhead. Here I compare the desaturation events to any breathing events looking for not only a drop is SpO2 but an increase in pulse rate. If the drop in SpO2 is a true reading, not an artifact from moving or something, then you will see an increase in pulse rate. The body will attempt to correct a drop in oxygen by increasing pulse rate.

So - the median values I also get from sleepyhead in the daily view I copy and paste the lines in the statistics area that is off on the left. I copy the 2 lines into excel (Pulse Rate and SpO2). You can also just type the numbers into excel if you like.

If you don't use sleepyhead, the median value is also reported in the oximetery report. The line to look for is "Basal SpO2(%)"and "Avg Pulse Rate(bpm)". You will find the numbers between these methods to vary slightly based on rounding. Sleepyhead reports with zero decimal places and the oximetery report displays one decimal place.

I have to agree that likely the doctor will not want to look at multiple reports, thus the reason I try to bring graphs to show trends so perhaps a report or two so they can see the overall trend. I like to copy sections in sleepyhead especially where I find a drop in SpO2, rise in pulse rate, and an event recorded from my machine. Kind of ties it all together.

Movement is the biggest factor for readings that jump around. It is most unfortunate that the pulse oximeter does that record the waveform that it displays. If it did then we would know when we were moving to disregard the values that are reported. Perhaps there is a way to tie in some of the movement software that is out there, but that sounds like a lot of work...

Here are a few resources:
http://www.hopkinsmedicine.org/healthli ... 92,P07754/
http://www.who.int/patientsafety/safesu ... ced_en.pdf
http://www.nonin.com/Go2Nonin/documents ... 0FINAL.pdf

I am not sure I agree with the concern in the WHO presentation with the big concern for values below 95% as I have read many times that the baseline value does vary by person.

You can also search this site as we have had a few conversations on pulse oximeters in the past.

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SleepWrangler
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Re: Oximeter .... how do I use this information?

Post by SleepWrangler » Sun Apr 20, 2014 9:21 am

I appreciate the feedback fellas.
JDS74 wrote:Just bring this report to your doctor.
I think this is a good idea. If nothing else it gives her one more piece of information as she performs her analysis.
pbriggs wrote:If you don't use sleepyhead, the median value is also reported in the oximetery report. The line to look for is "Basal SpO2(%)"and "Avg Pulse Rate(bpm)". You will find the numbers between these methods to vary slightly based on rounding. Sleepyhead reports with zero decimal places and the oximetery report displays one decimal place.
Unfortunately the newer (blue) CMS-50F doesn't work with sleepyhead just yet. I can definitely see that spikes in heart rate correlate to desaturation although I have not attempted to align that with flow patterns. I assume there is going to be a strong correlation there too.

With the results of detailed sleep and titration tests at her disposal, from a trusted source, I think this information has already been available if she needed to look.
pbriggs wrote:I have to agree that likely the doctor will not want to look at multiple reports, thus the reason I try to bring graphs to show trends so perhaps a report or two so they can see the overall trend. I like to copy sections in sleepyhead especially where I find a drop in SpO2, rise in pulse rate, and an event recorded from my machine. Kind of ties it all together.
She doesn't have SpO2 trend graphs and indicies over a long period of time available to her. That is something I can contribute in a few months if she wants to look.
pbriggs wrote:I am not sure I agree with the concern in the WHO presentation with the big concern for values below 95% as I have read many times that the baseline value does vary by person.
Makes me feel broken because my sleep SpO2 average is below their threshold. I may wear the oximeter during the day as a comparison.
pbriggs wrote:You can also search this site as we have had a few conversations on pulse oximeters in the past.
Good idea and have been doing that too. Lots of chaff compared to wheat so it takes a while to sift through all of the contributions. Good references from someone who has participated in or monitored useful discussions is always a big help.

Largely I assume the macro data is the most useful to verify brain damaging SpO2 events are not happening, and to monitor overall trends. Perhaps as I get macro AHI numbers in-line with therapeutic values I may dig into unflagged hypopneas and obstructions and correlate with SpO2 and heart rate to see if additional adjustments are necessary. For now I am content with just using flagged breathing events to make adjustments to therapy.

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Re: Oximeter .... how do I use this information?

Post by Jack_Russel_Fan » Sun Apr 20, 2014 10:56 am

The old CMS-50F is still available from pulseoxstore.com aka Cooper Medical Supplies. I purchased one online from then about a month ago!

Tom

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Re: Oximeter .... how do I use this information?

Post by HoseCrusher » Sun Apr 20, 2014 1:18 pm

Keep in mind that the WHO article targets oxygen levels during anesthesia during surgery. The target during normal sleep may be different...

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SpO2 96+% and holding...