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[princessbelle]

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[palerider]

These Cheyne Stokes Respirations are new, can some please explain what they are and what it means?
Thanks for all the help.

zoom in on it, to see what is happening, and then google the term for a thorough explanation.

[Pugsy]

Actually it is Periodic Breathing and not necessarily Cheyne Stokes Respiration.
Periodic Breathing definition...

Periodic Breathing is a Respironics data feature defined as a persistent waning and waxing breathing pattrn which repeats itself between 30 and 100 seconds. The nadir of the breathing pattern is characterized by at least a 40% reduction in airflow from an established baseline flow. The pattern must be present for several minutes before it can be identified as periodic breathing. No therapy adjustments are made in response to periodic breathing.

Cheyne-Stokes Respiration is just one form of periodic breathing. Not all PB flagged times are Cheyne-Stokes. Usually Centrals need to be a part of the PB flagged time frame and the breathing pattern is very specific with those centrals. I bet if we zoomed in on your PB time that the breathing shows really just a very gentle waxing and waning pattern and not the CSR pattern.

CSR pattern looks like this


And here is a couple of PB flagged time frame from one of my reports...no where near Cheyne Stokes pattern.

[princessbelle]

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[Pugsy]

Thank you for showing us the detailed image. CSR reporting by the new AirSense is new to ResMed and I didn't know what those reports looked like. It appears there is indeed a short flat line associated with the respirations but I guess it didn't last long enough to earn a flag to go along with it. They need to be at least 10 seconds (the flat line part) to earn a flag. Also the waxing and waning part of the respiration doesn't seem to be as pronounced as we would expect to see. Yours appears to barely do the waxing and waning thing.

The definition above that I used was Respironics definition. I haven't seen a definition yet to explain how ResMed comes up with it.
It might be in the manual but I haven't read all of the AirSense manual. Maybe later I will have time to try to figure out ResMed criteria for CSR.

At this point though for you...short periods of CSR appearing respiration is probably nothing to be all that worried about.
Especially if short lived and random.
If concerned by all means see your doctor but even very short lived periods of CSR with fully flagged centrals stuck in there aren't necessarily alarming.
It's more troublesome when we see it happening routinely and for much longer periods of time and often during the night.

[princessbelle]

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[palerider]

It appears there is indeed a short flat line associated with the respirations but I guess it didn't last long enough to earn a flag to go along with it. They need to be at least 10 seconds (the flat line part) to earn a flag. Also the waxing and waning part of the respiration doesn't seem to be as pronounced as we would expect to see. Yours appears to barely do the waxing and waning thing.

if she changed the scale on the flow line, it'd be a lot easier to see what was happening.

[Pugsy]

if she changed the scale on the flow line, it'd be a lot easier to see what was happening.

Yeah but I can still see that it isn't nearly like what I would expect to see with classic CSR even at this scale. Scary CSR can be spotted even zoomed out further than this one is.
If this were my report I wouldn't be alarmed at this point.
Even if it were true classic spot on CSR a one time short lived occurrence is unlikely to get a doctor to be worrying about anything unless there's a lot more going on with someone's medical history.

[palerider]

if she changed the scale on the flow line, it'd be a lot easier to see what was happening.

Yeah but I can still see that it isn't nearly like what I would expect to see with classic CSR even at this scale. Scary CSR can be spotted even zoomed out further than this one is.
If this were my report I wouldn't be alarmed at this point.
Even if it were true classic spot on CSR a one time short lived occurrence is unlikely to get a doctor to be worrying about anything unless there's a lot more going on with someone's medical history.

I agree on the not being alarmed.

[princessbelle]

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[bwexler]

I think he was suggesting you change the scale on the flow rate chart. It is currently 180-180 if it were changed to 90-90 that would make it much easier to see the wave pattern.

[princessbelle]

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[palerider]

Trust me I will not get alarmed with out asking anything first and results from my doctor. I made the graph bigger and I don't see a straight line they are jagged lines. Is this what you need palerider or should I zoom out more?

I was referring to right clicking on the scale at the left of the chart, and selecting autoscale, or even fixed, given that the scale is -180-180 on those, it smooshes down everything to almost flatness.

[Pugsy]

The sort of flat lines that I see are barely flat and brief and the respiration that follows looks maybe more like shallow breathing.
At 04:14:15 you see the start of sort of a flat line which a reduction in air flow and there's another at 04:15:30...it's a barely there line though. Neither appears to last 10 seconds and the breathing shape over all isn't as dramatic I would expect CSR to be.

Page 8 and 9 of the manual...do you have the provider/clinical manual?

Note where it shows the shape of the breathing.

[princessbelle]

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