Breathing and ECG1

8/3/2019 Breathing and ECG1

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The AASM Manual for theScoring of Sleep and

Associated Events

Respiratory Rules



Respiratory Rules

Technical Considerations

Event Duration

ApneaHypopnea

RERA

HypoventilationCheyne Stokes



Technical Considerations forAirflow

Use a thermal sensor to detect apnea.

Use nasal pressure to detect hypopnea

A square root transformation may be used tocorrect a small bias for over scoring hypopnea.

Use alternate sensors if recommended

sensor is unreliable For hypopnea, inductive plethysmography isconsidered an alternate).



Technical Considerations forRespiratory Effort

Use esophageal pressure or inductiveplethysmography to detect respiratoryeffort.Diaphragmatic/intercostal EMG is considered an

alternative sensor for respiratory effort ( norecording specifications are given).



Technical Considerations forBlood Oxygen

Pulse oximetry should be used tomeasure blood oxygen.

The maximum acceptable movingaverage window is 3 seconds.



Event Duration

For apnea or hypopnea:Beginning of event is nadir preceding the first

breath of event

End of event is beginning of first breath thatapproximates baseline (not defined).

When baseline can’t be determined,

terminate:

When there is a clear and sustained increase inamplitude.

When there is resaturation of at least 2%.



Nadir preceding1st reduced breath Beginning of first breath

Approximating baseline



Apnea

Thermal sensor amplitudeattenuated ≥ 90%.

Duration ≥ 10 seconds.90% of event meets amplitudecriteria.

No saturation criterion.



Apnea

Obstructive if sustained or increasedinspiratory effort throughout.

Central if inspiratory effort absent.

Mixed if inspiratory effort initiallyabsent but resumes in latter portionof event.



Obstructive Apnea

10 Seconds

Paradoxical motion

Absent Airflow



Thermal

Pressure

Snore

SpO2

RIP Sum

RIP RC

RIP ABD

10 Seconds



RIP Sum

RIP RC

RIP ABD

SpO2

Snore

Pressure

10 seconds



10 seconds

Thermal

Pressure

Snore

SpO2

RIP Sum

RIP RC

RIP ABD


http://slidepdf.com/reader/full/breathing-and-ecg1 14/34Sleep onset Central Apnea

10 SecondsAbsent Airflow

Absent Effort



Thermal

Pressure

Snore10 seconds

SpO2

RIP Sum

RIP ABD

RIP RC



10 Seconds

Central Obstructive

Mixed Apnea



Hypopnea

Recommended

Reduction of nasal pressure amplitude

of ≥ 30%.

Duration ≥ 10 seconds.

Desaturation ≥ 4% below pre-eventbaseline.

90% of event meets amplitude criteria.



Hypopnea

10 Seconds

Reduced Airflow

Snoring

Desaturation >= 4%

Phase Shift



Thermal

Pressure

Snore

10 seconds

SpO2

RIP Sum

RIP ABD

RIP RC



Hypopnea

Alternative

Reduction of nasal pressure amplitude

of ≥ 50%.

Duration ≥ 10 seconds.Desaturation ≥ 3% below pre-event baseline

OR

The event is associated with arousal.90% of event meets amplitude criteria.



Cheyne Stokes Breathing

Three consecutive cycles of cyclicalcrescendo-decrescendo change inbreathing amplitude.

AND Five or more central apneas or

hypopneas per sleep hour.

OR Crescendo-decrescendo pattern has

duration of ≥ 10 minutes.



10 Seconds

Cheyne Stokes Breathing

Crescendo- Decrescendo pattern



Respiratory Event RelatedArousal (RERA)

OPTION

Ten or greater second sequence ofbreathes.

Evidence of increased respiratory effort,

flow limitation or both.

Terminal arousal.

Does not meet apnea or hypopnea criteria.



Respiratory Effort Related Arousal

10 Seconds

Flow Limitation



Respiratory Effort Related Arousals

10 Seconds

Flow Limitation

Crescendo Snoring



RERA





Hypoventilation

OPTION

Ten mm Hg or greater increase ofPaCO

2

during sleep compared towake (supine).

May be measure with end tidal ortranscutaneous capnometry.





The AASM Manual for theScoring of Sleep and

Associated Events

Cardiac Events



ECG LEAD

Modified Lead II.

Right arm lead placed on R shoulder.

Left leg lead placed on torso (sixthintercostal space).



Scoring Rules

Sinus tachycardia when sustainedsinus rate> 90 BPM.

Bradycardia when sustained sinus rate< 40 BPM.

Asystole when cardiac pauses >3seconds.



More Scoring Rules

Wide complex tachycardia* when: 3 consecutive beats or more.

rate > 100 BPM.

QRS duration ≥ 120 msec.

Narrow complex tachycardia when: 3 consecutive beats or more.

rate > 100 BPM.

QRS duration < 120 msec.



One Last Scoring Rule

Atrial Fibrillation when: irregularly irregular ventricular rhythm.

no P waves

rapid oscillations of variable size, shape andtiming.

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Breathing and ECG1