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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4696_Библиотеки_им_академика_М_И_Перельмана
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Fig. 3.22 When the patient downloads the data onto their own computer, the contents of the SD
card are presented in this way (arrow). (Figure source: own work)
3 Respiratory Flow Curve
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Fig. 3.23 The patient must select all folder content, then right click the cursor, and send it to a
“Compressed File”. You need to instruct the patient on how to send to you this compressed folder
by e-mail (often the content, even if compressed, has been large; in these cases, is better to send it
by using GoogleDrive, Dropbox, or any other tool that can manage large les). (Figure source:
own work)
3.6 How toShare Detailed Graph Data
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a
b
Fig. 3.24 In this example, the data le came with the name “Identication(2).tgt” and was
renamed to “Identication.tgt” to be properly recognized by the ResScan™ system. (Figure
source: own work)
3.7 Procedure when Respiratory Flow Curve Is
Not Displayed
Ensure to have the latest version of the ResScan™ software. Be careful to always
work with the latest software for any positive pressure equipment manufacturer you
want to analyze high-resolution data.
Install a new version, if applicable. However, if this does not resolve the prob-
lem, follow these steps.
3.7.1 First Options forShowing theFlow Curve
On the ResScan™ home screen, click on the “Reports” option (Fig.3.25). Then
click on the “Customize” option (Fig.3.26). Click on the “Detailed Graphs” option
(Fig.3.27). Conrm that the “Flow” plots are in this window. Otherwise, add the
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Fig. 3.25 Click on the “Reports” option. (Figure Copyright ResMed (with permission))
3.7 Procedure when Respiratory Flow Curve Is Not Displayed
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Fig. 3.26 Click the Customize option. (Figure Copyright ResMed (with permission))
3 Respiratory Flow Curve
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Fig. 3.27 Click in the window on the right, on the Detailed Graph option. (Figure Copyright
ResMed (with permission))
“Flow” plots in this window. If it is not, look for the “Flow” option in the left win-
dow, select this option and clicking the ADD button between the two windows
(Fig.3.28).
3.7.2 Second Option forViewing theFlow Curve
Check on the “Navigation” screen that the “Flow” is correctly selected and that the
number of visible graphs corresponds to the option selected (Fig.3.29).
3.7 Procedure when Respiratory Flow Curve Is Not Displayed
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Fig. 3.28 Conrm that the “Flow” plot is in the Detailed Graphs window. Otherwise, add the Flow
plot in this window looking for the “Flow” option in the left window, select this option, and click
the ADD button between the two windows. (Figure Copyright ResMed (with permission))
Fig. 3.29 Check that the “Flow” is properly selected on the “Navigation” screen (dotted circle)
and that the number of visible graphs matches the option you selected (arrow). (Figure Copyright
ResMed (with permission))
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3.8 Further Reading
Airow analysis is also discussed in the book Advances in the Diagnosis and
Treatment of Sleep Apnea (series title: Advances in Experimental Medicine and
Biology—doi.org/10.1007/978- 3- 031- 06413- 5). The chapter “Airow Analysis in
the Context of Sleep Apnea” reviews the main methodological approaches applied
to characterize and extract relevant information from respiratory airow signal [12].
References
1. Gay P, Weaver T, Loube D, Iber C, Force PAPT, SoP C, etal. Evaluation of positive airway
pressure treatment for sleep related breathing disorders in adults. Sleep. 2006;29(3):381–401.
2. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, etal. Relationship
between hours of CPAP use and achieving normal levels of sleepiness and daily functioning.
Sleep. 2007;30(6):711–9. https://doi.org/10.1093/sleep/30.6.711.
3. Guerrero A, Embid C, Farre R, Navajas D, Masa JF, Duran J, etal. Sleep breathing ow char-
acteristics as a sign for the detection of wakefulness in patients with sleep apnea. Respiration.
2010;80(6):495–9. https://doi.org/10.1159/000264656.
4. Ayappa I, Norman RG, Whiting D, Tsai AH, Anderson F, Donnely E, etal. Irregular respira-
tion as a marker of wakefulness during titration of CPAP.Sleep. 2009;32(1):99–104.
5. Ayappa I, Norman RG, Suryadevara M, Rapoport DM. Comparison of limited monitoring
using a nasal-cannula ow signal to full polysomnography in sleep-disordered breathing.
Sleep. 2004;27(6):1171–9. https://doi.org/10.1093/sleep/27.6.1171.
6. Hosselet JJ, Norman RG, Ayappa I, Rapoport DM.Detection of ow limitation with a nasal
cannula/pressure transducer system. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1461–7.
7. Nguyen CD, Amatoury J, Carberry JC, Eckert DJ.An automated and reliable method for
breath detection during variable mask pressures in awake and sleeping humans. PLoS One.
2017;12(6):e0179030. https://doi.org/10.1371/journal.pone.0179030.
8. Al-Halhouli A, Al-Ghussain L, El Bouri S, Liu H, Zheng D.Clinical evaluation of stretchable
and wearable inkjet-printed strain gauge sensor for respiratory rate monitoring at different
measurements locations. J Clin Monit Comput. 2021;35(3):453–62. https://doi.org/10.1007/
s10877- 020- 00481- 3.
9. Arora N, Meskill G, Guilleminault C.The role of ow limitation as an important diagnos-
tic tool and clinical nding in mild sleep-disordered breathing. Sleep Sci. 2015;8(3):134–42.
https://doi.org/10.1016/j.slsci.2015.08.003.
10. Rapoport D, Norman R, Nielson M. Nasal pressure airow measurement–an introduction.
Corpus Christi, TX: Pro-Tech. Services; 2001.
11. Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM scoring
manual updates for 2017 (version 2.4). J Clin Sleep Med. 2017;13(5):665–6. https://doi.
org/10.5664/jcsm.6576.
12. Barroso-García V, Jiménez-García J, Gutiérrez-Tobal GC, Hornero R.Airow analysis in the
context of sleep apnea. In: Penzel T, Hornero R, editors. Advances in the diagnosis and treat-
ment of sleep apnea: lling the gap between physicians and engineers. Cham: Springer; 2022.
p.241–53.
References
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57© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
V. S. Piccin, Monitoring Positive Pressure Therapy in Sleep-Related Breathing
Disorders, https://doi.org/10.1007/978-3-031-50292-7_4
Chapter 4
Assessment oftheRespiratory Flow Curve
4.1 Understanding ofAlgorithms
Polysomnography (PSG) is a sleep study that uses electroencephalogram, electro-
oculogram, electromyogram, electrocardiogram, and pulse oximetry, as well as air-
ow and respiratory effort, to assess the underlying causes of sleep disturbance.
Two quality airow sensors are used in the PSG. The oronasal thermal sensor
(thermistor) detects temperature changes in inhaled or exhaled respiration to moni-
tor airow and is best used to identify apneas (90% reduction in airow). The nasal
pressure transducer detects pressure changes during inhalation and exhalation to
monitor airow and is used to identify hypopnea (30% reduction of airow). In
addition, two respiratory inductance plethysmography sensors or straps are used to
determine the qualitative respiratory effort in the chest and abdomen. These sensors
identify the various types of respiratory events, including obstructive apnea, obstruc-
tive hypopnea, and central apnea [1].
During the PSG examination, oxygen saturation is obtained through pulse oxim-
etry and is used to assist with scoring hypopneas when there is at least a 3% or 4%
oxygen desaturation (depending on whether the recommended AASM or acceptable
scoring criteria is used) associated with the respiratory event. Also, PSG detects
arousals from sleep stages N1, N2, N3, or REM when there is an abrupt shift of the
electroencephalogram frequency in the alpha or theta range, or frequencies greater
than 16Hz, lasting for at least 3s [1].
PSG is the gold standard for diagnosing sleep-related breathing disorders, which
include obstructive sleep apnea (OSA), central sleep apnea, and sleep-related
hypoventilation/hypoxia [1].
Positive airway pressure (PAP) devices– like continuous, auto-adjusting, and
bilevel machines, can also measure airow and circuit pressure to detect and store
the memory mask on time and the occurrence of respiratory events. The algorithms
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for event detection used by these devices are based on measurements of airow,
vibration, and airow prole attening [2].
Detection of events from PAP devices shows the same variables obtained on
polysomnogram (PSG), including apnea-hypopnea index (AHI), apnea index (AI),
and hypopnea index (HI). However, although health professionals use the event
detection information recorded by these PAP devices to assess treatment efcacy,
PAP devices and PSG differ in the methods used to generate these measures. PAPs
use airow to detect apnea and hypopnea. In contrast, the abnormal respiratory
events on PSG are scored using not only airow but also the arterial oxygen satura-
tion level, respiratory effort, and, depending on the scoring criteria, electroencepha-
lographic (EEG)/electromyographic (EMG) arousals.
Due to differences in how PAP and PSG detect respiratory events and generate
indices of respiratory events, it is very important that healthcare practitioners under-
stand how these measures compare to each other [2].
It is also essential for sleep care professionals to be aware that each manufacturer
has developed their own algorithm for their positive airway pressure machines. In
this book, we discuss the algorithm developed for ResMed for devices commonly
used to treat sleep apnea.
4.1.1 Obstructive or Central Apneas
When analyzing the respiratory ow curve generated by the PAP device, in regular
respiration, the respiratory ow curve will have a characteristic design, as shown in
Fig.4.1.
Time (30 seconds)
Respiratory
cycle
Inhalation
Exhalation
Respiratory flow (1/min)
Fig. 4.1 The arrow shows the “zero“point which marks the transition from inspiration to exhala-
tion. We note here that the inhalation curve is relatively rounded (half circle dashed), and that the
expiration curve is slightly longer than the inhalation curve. Inhalation ends at the beginning of
exhaling and exhaling ends at the beginning of inhalation. The sum of an inspiratory curve and an
exhalation curve is referred to as the breathing cycle and appears as a sine wave (dashed parallel
bars). In a one-minute window, we should expect to nd 14–20 breathing cycles (here we have a
30-s window to better observe the respiratory waveform). In general, we expect the maximum
inspiratory ow rate to be about 20L/min, but this value will show some individual variations.
(Source: author’s collection)
4 Assessment oftheRespiratory Flow Curve
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