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11/20/2015
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Eighth Bi-Annual Pediatric Sleep Medicine Conference
November 12-15, 2015Omni Amelia Island Plantation Resort
Amelia Island, Florida
Sponsored byThe Warren Alpert Medical School
of Brown University
Carol L. Rosen, MD
Case Western Reserve University School of Medicine
Rainbow Babies & Children’s Hospital
Cleveland, OH
No relevant financial conflicts of interest to this presentation
For respiratory-related PSG findings◦ Practice pattern recognition skills
◦ Recognize commonly encounters artifacts
Audience participation
Have fun
A. Central apneaB. Mixed apneaC. Obstructive apneaD. Obstructive hypopnea
120 sec
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A. Central apneaB. Mixed apneaC. Obstructive apneaD. Obstructive hypopnea
120 sec 120 sec in REMA. Central apneaB. Central hypopneaC. Obstructive apneaD. Obstructive hypopnea
120 sec in REMA. Central apneaB. Central hypopneaC. Obstructive apnea -uberD. Obstructive hypopnea Bonus Q, another event?
Hypopnea
41 Seconds
Inspiratory Breath Hold
Tachypnea
A. AchondroplasiaB. Congenital central hypoventilation C. Prader-WilliD. Rett’s
41 Seconds
Inspiratory Breath Hold
Tachypnea
A. AchondroplasiaB. Congenital central hypoventilation C. Prader-WilliD. Rett’s
Marcus CL et al. Polysomnographic characteristics of patients J Pediatr 1994;125:218-24.
EtCO2 values ~ 42 mmHgSpO2 average 97% with episodic desaturations
A. Central hypoventilationB. Central sleep apneaC. Heart failureD. Obstructive sleep apnea
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EtCO2 values ~ 42 mmHgSpO2 average 97% with episodic desaturations
A. Central hypoventilationB. Central sleep apneaC. Heart failureD. Obstructive sleep apnea
A. BruxismB. Load compensationC. Palatal myoclonusD. Snoring
N3 , 30 sec
A. BruxismB. Load compensationC. Palatal myoclonusD. Snoring
N3 , 30 sec120 secSpO2 averages 94%
EtCO2 average 35 mmHg
120 sec
#1 flow limitation
#2 tachypnea; >50 breaths/min
#3 SpO2 94%
Bonus question: is EtCO2 reliable? why or why not?
Not: likely underestimates because of tachypnea
A. OxygenB. PHOX2BC. Pulmonary referralD. Reassurance
120 sec in N3 sleepSpO2 mean 97%EtCO2 mean 35 mmHg
TcCO2 mean 41 mmHg
= 35 breaths/min
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A. OxygenB. PHOX2BC. Pulmonary referralD. Reassurance
Tachypnea (-35/hr) with normal gas exchange
120 sec in N3 sleepSpO2 mean 97%EtCO2 mean 35 mmHgTcCO2 mean 41 mmHg = 35 breaths/min
120 sec120 sec
120 sec
A. Flow limitationB. HyperventilationC. Obstructive hypoventilationD. Technical problem
120 sec in N2 sleepSpO2 85- 97%EtCO2 mean 25 mmHg
A. Flow limitationB. HyperventilationC. Obstructive hypoventilationD. Technical problem
120 sec in N2 sleepSpO2 85- 97%EtCO2 mean 25 mmHg
No Pleth WaveformBad Pleth: SpO2 85-97%
Good Pleth: SpO2 98%
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120 sec in N3 sleepSpO2 mean 96%EtCO2 mean 54 mmHg
A. Normal breathingB. Obstructive hypoventilationC. Central hypoventilationD. Sleep-related hypoxemia
120 sec in N3 sleepSpO2 mean 96%EtCO2 mean 54 mmHg
A. Normal breathingB. Obstructive hypoventilationC. Central hypoventilationD. Sleep-related hypoxemia
EtCO2 wave
EtCO2 # 39 mmHg
Airflow
Chest effort
Abd effort
SpO2 100%90%
41 mmHg40 mmHg
Desat to 84%
36 mmHg38 mmHg
10 sec
Snore/noise
60 sec fragmentA. Cardiac evaluation
B. CNS imaging
C. CPAP titration
D. PHOX2B testing
EtCO2 wave
EtCO2 # 39 mmHg
Airflow
Chest effort
Abd effort
SpO2 100%90%
41 mmHg40 mmHg
Desat to 84%
36 mmHg38 mmHg
10 sec
Snore/noise
60 sec fragmentA. Cardiac evaluation
B. CNS imaging
C. CPAP titration
D. PHOX2B testing
A. AnemiaB. Abnormal hemoglobinC. Hydroxyurea therapyD. Obstructive sleep apnea
120 sec in N3 sleepSpO2 mean 84%EtCO2 mean 38 mmHg
A. AnemiaB. Abnormal hemoglobinC. Hydroxyurea therapyD. Obstructive sleep apnea
120 sec in N3 sleepSpO2 mean 84%EtCO2 mean 38 mmHg
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A. Cheyne-Stokes respirationB. Central sleep apneaC. Central sleep apnea with hypoventilationD. Obstructive sleep apnea
120 sec in sleepSpO2 mean 92%TcCO2 61 mmHg
A. Cheyne-Stokes respirationB. Central sleep apneaC. Central sleep apnea with hypoventilationD. Obstructive sleep apnea
120 sec in sleepSpO2 mean 92%TcCO2 61 mmHg
120 sec in wakeSpO2 mean 98%
EtCO2 4020 mmHg
A. Cardiogenic artifactB. Cell phone artifactC. Diaphragm flutterD. Panic attack
120 sec in wakeSpO2 mean 98%
EtCO2 4020 mmHg
A. Cardiogenic artifactB. Cell phone artifactC. Diaphragm flutterD. Panic attack
Thank [email protected]