CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

jnk wrote:

Muffy wrote:Y'know, I don't really ask a lot of questions around here, but can I ask one now?

Muffy

OK. But hurry. You only have 122 posts left.

jeff

OK, great.

Thanks.

Muffy

Muffy wrote:

jnk wrote:

Muffy wrote:Y'know, I don't really ask a lot of questions around here, but can I ask one now?

Muffy

OK. But hurry. You only have 122 posts left.

jeff

OK, great.

Thanks.

Muffy

I hope you keep using the Muffy identity well beyond the 1,000th post. And I say that even though your posts hurt me in two ways: Either you teach to the point of making my head hurt or you crack jokes to the point of making me laught till my sides hurt. Often, both.

So, please, let Muffy keep going as she is to at least 2,000 posts?! Please?!

Another edf reader (not crazy about this one)(to put it mildly):



Anyway, bb PLMs generate arousals which in turn cause central phenomenon. Incidental flow limitation is seen.

Muffy

Muffy wrote:Anyway, bb PLMs generate arousals which in turn cause central phenomenon. Incidental flow limitation is seen.

Hi Muffy, Thank you for that image. So early on in the night I am getting considerable arousals from PLMs, right? i.e. treat the PLMs=>sleep better.

Also, as a result of going to a wedding last night I imbibed my fair share of red wine (well I have been such a good boy for a while now ; also I stayed up to see Sam Stosur play in the French Open final). Interesting for me to see the ASV DL from last night http://users.adam.com.au/sixsome/ASV/0610/060510/, in particular:
Surely this clearly demonstrates that the ASV is fooled by something in my breathing, otherwise how else could my RR increase by roughly a factor of 3 for a period of about 3/4 hour (see around 0100) with little change in tidal volume and minute ventilation? Cheers,

blizzardboy wrote: . . . I am getting considerable arousals from PLMs, right? i.e. treat the PLMs=>sleep better. . . .

Birgit Högl, M.D., in [i]Journal of Clinical Sleep Medicine,[/i] Vol. 3, No. 1, 2007 wrote:"It is well established that PLMS are associated with microarousals and autonomic activation and therefore associated with an alteration in sleep structure. Whereas older concepts assumed that PLMS caused those arousals, more recent studies revealed, that PLMS and arousals are associated in another, more complex and non-unidirectional manner: Arousal equivalents, e.g. delta waves, heart rate increases or other changes in cerebral and autonomic activity can herald PLMS. In the most recent scoring criteria for periodic leg movements (PLM), this has been taken into account and a PLM with an arousal can be scored even if the arousal precedes the onset of a PLM."--http://www.aasmnet.org/JCSM/Articles/030102.pdf

blizzardboy wrote:So early on in the night I am getting considerable arousals from PLMs, right? i.e. treat the PLMs=>sleep better.

Keep in mind that this is the diagnostic (no pressure support), but yes, PLMs that generate arousals deserve consideration for treatment.

blizzardboy wrote:Surely this clearly demonstrates that the ASV is fooled by something in my breathing, otherwise how else could my RR increase by roughly a factor of 3 for a period of about 3/4 hour (see around 0100) with little change in tidal volume and minute ventilation?

How weird is that? I would think that Minute Ventilation would be a calculated value:

(VT)(f) = VE

so that one is certainly a puzzler. VE should be the better part of 15 liters at that point.

Do you have the PSG raw data from the ASV titration?

Muffy

jnk wrote:

blizzardboy wrote: . . . I am getting considerable arousals from PLMs, right? i.e. treat the PLMs=>sleep better. . . .

Birgit Högl, M.D., in [i]Journal of Clinical Sleep Medicine,[/i] Vol. 3, No. 1, 2007 wrote:"It is well established that PLMS are associated with microarousals and autonomic activation and therefore associated with an alteration in sleep structure. Whereas older concepts assumed that PLMS caused those arousals, more recent studies revealed, that PLMS and arousals are associated in another, more complex and non-unidirectional manner: Arousal equivalents, e.g. delta waves, heart rate increases or other changes in cerebral and autonomic activity can herald PLMS. In the most recent scoring criteria for periodic leg movements (PLM), this has been taken into account and a PLM with an arousal can be scored even if the arousal precedes the onset of a PLM."--http://www.aasmnet.org/JCSM/Articles/030102.pdf

Hi jnk, So the PLMs are the egg and "arousal equivalents" are the chicken...

Muffy wrote:I would think that Minute Ventilation would be a calculated value: (VT)(f) = VE...so that one is certainly a puzzler. VE should be the better part of 15 liters at that point.

Hear, hear.

Muffy wrote:Do you have the PSG raw data from the ASV titration?

Yes, I will upload and post link. Cheers,

blizzardboy wrote:I will upload and post link

Voila:
http://rapidshare.com/files/395763796/asv_C3A2.rec
http://rapidshare.com/files/395764511/asv_C4A1.rec
http://rapidshare.com/files/395765242/asv_CPAP.rec
http://rapidshare.com/files/395765546/asv_CPAPF.rec
http://rapidshare.com/files/395765842/asv_dB.rec
http://rapidshare.com/files/395766592/asv_ecg.rec
http://rapidshare.com/files/395767176/asv_EMG.rec
http://rapidshare.com/files/395767614/asv_EtCO2.rec
http://rapidshare.com/files/395771212/asv_SpO2.rec
http://rapidshare.com/files/395768219/asv_legL.rec
http://rapidshare.com/files/395769134/asv_legR.rec
http://rapidshare.com/files/395769807/asv_LOC.rec
http://rapidshare.com/files/395771119/asv_ROC.rec
http://rapidshare.com/files/395770189/asv_posn.rec
http://rapidshare.com/files/395771415/asv_thor.rec
http://rapidshare.com/files/395762954/asv_abdo.rec
Cheers,

BB

Just accept that God has you covered & is delivering miracles - air when it doesn't add up

Cheers

DSM

PS What a bummer re Sam - all that late night watching (so sure of victory we were) & Italy walks away with it - just ain't fair

D

dsm wrote:Just accept that God has you covered & is delivering miracles - air when it doesn't add up

Hi DSM, aah ...ASV=(The) Almighty's Sacred Ventilation - works in mysterious ways? It truly is the saviour of all (SDBers) - I believe! Cheers,

blizzardboy wrote:I will upload and post link

OK, great, gimme a minute to get this set up...

OK, this might be the explanation for the high respiratory rate W/O significant change in VT or VE:



There are several areas in the ASV study where you "stutter"- several inspiratory efforts registered within a single breath (read the CPAP Flow channel). This could be perceived as a high respiratory rate, but the total volume of the breath is similar to surrounding "normal" breaths (however, that is an uncalibrated "flow" channel and not a "volume" channel, so the actual calculation cannot be performed).

Muffy

It seems pretty clear that the respiratory instability (read CPAP Flow) in this area is a direct result of the PLMs (read L Leg-- R Leg is blown):



Muffy

jnk wrote:

blizzardboy wrote: . . . I am getting considerable arousals from PLMs, right? i.e. treat the PLMs=>sleep better. . . .

Birgit Högl, M.D., in [i]Journal of Clinical Sleep Medicine,[/i] Vol. 3, No. 1, 2007 wrote:"It is well established that PLMS are associated with microarousals and autonomic activation and therefore associated with an alteration in sleep structure. Whereas older concepts assumed that PLMS caused those arousals, more recent studies revealed, that PLMS and arousals are associated in another, more complex and non-unidirectional manner: Arousal equivalents, e.g. delta waves, heart rate increases or other changes in cerebral and autonomic activity can herald PLMS. In the most recent scoring criteria for periodic leg movements (PLM), this has been taken into account and a PLM with an arousal can be scored even if the arousal precedes the onset of a PLM."--http://www.aasmnet.org/JCSM/Articles/030102.pdf

They reported that PLMS are associated with cardiac acceleration, even in the absence of arousal.

Coarsely, I think that appears to be true in bb's case, but we need to run a different routine to analyze that.

Muffy