Which is the most normal waveform?

[SingleH]

Hi all,

Can anyone tell me which out of the two screenshots below resembles the most "normal" of a breathing waveform. These are taken from the same nights sleep. Is it normal to just constantly change back and forward between periods of these two forms.

Thanks.


       

[G. Szabo]

A "normal wave," i.e., the one observed in healthy individuals, has smooth sinusoidal peaks both in the inhalation and exhalation max/min regions.

[SingleH]

Thanks G. Szabo,

Of the two waveforms I posted, which would you say looks better?

[BigWing]

The first waveforms look much more normal and ideal - very smooth mostly.

In the second, I believe all the little 'wiggles' represent flow limitations of some form - the flattened tops certainly do (but I'm no expert!).

[G. Szabo]

I am not an expert either. You can decide it yourself after visiting:
https://www.youtube.com/watch?v=Syv7YcHb...=3&t=1409s
and seeing the waveforms of healthy individuals presented by Dr. Barry Krakow.

[BoxcarPete]

A "normal wave," i.e., the one observed in healthy individuals, has smooth sinusoidal peaks both in the inhalation and exhalation max/min regions.

Not true. Inhale should be curved on top like a sine wave, but exhale should be passive (i.e. relaxing the diaphragm and intercostal muscles, letting their natural elasticity expel the air) and as such appear more like an upside-down exponential decay. Once air ceases to flow, a new cycle begins with the rounded top inhale and a quickly decaying exhalation flow.

[G. Szabo]

Not true. ... exhale should be passive ... and as such appear more like an upside-down exponential decay. Once air ceases to flow, a new cycle begins with the rounded top inhale and a quickly decaying exhalation flow.

Would you mind having a look at the flow chart of healthy individuals? at 27:14 of the following link? 
When to Prescribe Advanced PAP Therapies for Patients Struggling with CPAP (youtube.com)

Also, please note that I was commenting on the peaks' shape, not the decay part.
Thank you for your attention.
Best

[BigWing]

I am not an expert either. You can decide it yourself after visiting:
https://www.youtube.com/watch?v=Syv7YcHb...=3&t=1409s
and seeing the waveforms of healthy individuals presented by Dr. Barry Krakow.

Wow that is a fascinating video! It contains TONS of interesting data, and I just wish I could digest 1% of it! I will keep watching it over and over and trying to take in more and more.

My wife couldn't help laughing though. She's sat at the other computer in here and could hear what I was listening to, but couldn't resist noting that I kept snoring as I 'watched' it! I told her it's my age (over 70) - not the sleep apnea.

[SingleH]

I am not an expert either. You can decide it yourself after visiting:
https://www.youtube.com/watch?v=Syv7YcHb...=3&t=1409s
and seeing the waveforms of healthy individuals presented by Dr. Barry Krakow.

Thank you G.Szabo for this gem of a video!! The section of the video by Dr Barry Krakow was excellent and has answered far more than I expected. In fact it has helped clarify what was my very first post on this forum which was specifically about normalising respiratory waveforms.

Barry's alternative view of focusing the treament on normalising the waveform as oppose to treating AHI's was interesting, as was his point on the critical importance of eliminating flow limitations to normalise the waveform. Going back through Oscar data, when flow limits are eliminated, the waveform in my first screen shot take place, when flow limits are present the second waveform takes place. This video helped tie things together and gives me a new direction to focus on in terms of titration.

The info on ASV and REM was also interesting as was the connection with nocturia being a sign of failed treatment.

[G. Szabo]

Thank you G.Szabo for this gem of a video!!

Well, I found this video reference on this panelboard a while ago. So, I want to express my appreciation for our community's help!