.

rested gal wrote:The SpO2 was doing what during those "events?"
Since they're already scored and have been stamped "inspiratory flow limitation" I suppose the SpO2 wasn't doing the obligatory percentage of drop (3%? 4%? I never can remember which) to earn them official hypopnea status.

The effort belts are showing what during each "event?"

The EEG is showing what regarding "stage" and "arousals?"

Them are exactly the questions that need to be asked!

I put the IFL labels there to better define the area. Here is the actual record with the requested channels:

So in these epochs, NO respiratory events are scored!

That's terrible!

Isn't it?

NotMuffy wrote:So in these epochs, NO respiratory events are scored!

That's terrible!

Isn't it?

Sorry for being the slow student today.

But why is there no respiratory event scored? Not even a flow limitation? I got lost.

In NPSG scoring, FL is not an event, and if we use the 4A Hypopnea Rule, which requires a 4% desaturation, since there are no desats that meet criteria there can be no hypopneas.

This only leaves the possibility of RERAs (which would require an arousal).

Since an arousal was placed, it would seem that the first respiratory event should have been scored a RERA.

But I believe the arousal was not properly scored. To have an arousal in REM, you also need to have an increase in EMG. And while there is some activity in the EMG there, that looks more like artifact to me.

Consequently, with no arousal there can be no RERA, and the apparent oversight of the RERA ended up as a correct interpretation-- no qualifying respiratory events.

Ready for another one?

i would think part of it has to do with a lack of desaturation.

NotMuffy wrote:

Ready for another one?

Yep. As long as you're wiling to keep posting, I'll continue to be an avid reader. Thanks

And while there is some activity in the EMG there, that looks more like artifact to me.

A good illustration of why experienced interpreters are necessary. And why I'm still skeptical about substitutes like the Watch-Pat.

NM, if you collected all your informative posts, you would have the basis of an excellent book for Pappers who seek a deeper understanding of their condition. I'd buy it.

Although not quite done with this one yet.

If the sleep staging was done improperly (it's not really REM), then we can go back and score the arousals and call those events RERAs, or, using the more liberal 4B Hypopnea Rule, hypopneas.

And if you recall about 200 posts ago, we started out by saying the OP has (at least at the time) CompSAS, and consequently no events in REM. Now, there are events in REM? So I think that at least gives us a good reason to double check the scoring.

But we need to add more channels.

NotMuffy wrote:To have an arousal in REM, you also need to have an increase in EMG. And while there is some activity in the EMG there, that looks more like artifact to me.

So, why's the abdomen doing what it's doing right then? Artifact there, too? Perhaps an elf hopping on the tummy to get across to the other side of the bed.

I'm in a silly mood this evening, so I'll say the person started to have hiccups. Then didn't. Gotta have at least two hiccups per 30 second epoch for at least three epochs in a row, or none of 'em count as hiccups.

So, what would the EMG have looked like had there been RERA-ish EMG activity in REM rather than possible EMG artifact? I thought REM produces all kinds of fireworks going off in the EMG. Is that really REM going on there?
Is it time to look at the eyes and chin in the slow unveiling of all the channels? Not that I'd have any idea what I'm looking for other than some mirror image swooping eyerolls.

http://dictionary.reference.com/browse/hiccup

Word Origin & History

hiccup
1580, hickop, earlier hicket, hyckock, considered imitative of the sound of hiccupping (cf. Fr. hoquet, Dan. hikke, etc.); modern spelling first recorded 1788; hiccough (1626) is by mistaken association with cough. Replaced O.E. ælfsogoða, so called because hiccups were thought to be caused by elves.
Online Etymology Dictionary, © 2010 Douglas Harper


Rats...after writing all this, and hitting "Submit", I got my "Is that really REM" in too late!

rested gal wrote:I thought REM produces all kinds of fireworks going off in the EMG.

Negatory. In REM, the EMG is the tiniest it gets all night.

"EMG Fireworks in REM" would be suggestive of REM Behavior Disorder (movement in a sleep stage that should be atonic).

OTOH, EOG can get pretty busy.

NotMuffy wrote:

rested gal wrote:I thought REM produces all kinds of fireworks going off in the EMG.

Negatory. In REM, the EMG is the tiniest it gets all night.

I was thinking "EEG" when I saw "EMG." I don't do any better with acronyms than I do with decimal points!

I should'a known what EMG was measuring.
Heaven knows I got a good look-see at my EMG line... tick, tick, tick, kick, tick, tick, tick, kick. Well, more ticks between than that, but anyway.

NotMuffy wrote:"EMG Fireworks in REM" would be suggestive of REM Behavior Disorder (movement in a sleep stage that should be atonic).

OTOH, EOG can get pretty busy.

Yeah, let us see those rolling eyes. If they were rolling.

rested gal wrote:Yeah, let us see those rolling eyes. If they were rolling.

They are not, and you got your k and some spindle stuff, so that area needs to be rescored as NREM2:



which makes those respiratory events either RERAs or 4B Hypopneas.

BTW, rolling eyeballs, appearing in unambiguous REM look like:

Hypopnea scorecard from our friends at Binary:

rested gal wrote:So, why's the abdomen doing what it's doing right then? Artifact there, too?

That's very observant, RG!

You're right, the abdominal belt looks completely dyssynchronous with the flow and thoracic channels (it appears to go down when the other 2 go up, and vice versa).

In addition, the chest belt looks to be quite dampened (although that is more apparent in other epochs).

Inverting the abdominal channel corrects the supposed dyssynchony, but changing the filter settings to the factory recommendations of a popular RIP belt ("New") shows:



that the belt is probably bad and aggressive filter manipulation was used to try to recover the signal.

But no, the abdominal signal doesn't look like a hiccup there, more like a slightly broken-up (3-part) inspiration, perhaps due to the arousal (like maybe a stuttery sigh).

(OK, let's see. This a 60 second view, or 2 epochs, so there's 350 more of these, but there's 12 more channels, so maybe 1050 more discussions...)

Y'know, with the topic of abdominal-thoracic asynchrony going on in the other thread, this would be a great time to microanalyze belt activity in "." and see how it behaved. Mayhaps we can finally define if these were obstructive- or central-oriented, and whether it is an "SDB" problem or simply an "S" problem (and frankly, given the amount of sleep disruption and severely delayed REM onset, antidepressant effect cannot be ruled out here):

Following topic.