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Report
Interpretation
Guide
FOR CLINICAL USE ONLY
V1.0 June, 2011
ResMed Software Support
Hours 5:30 AM to 5:30 PM (Pacific Time) MondayFriday
Phone +1 (800) 424-0737, Option 6
Email TechSupportUSA@resmed.com
ResScan | Report Interpretation Guide 1
Table of Contents
Purpose of This Guide......................................................... 2 Detailed Data Graphs................................................................................. 38
Detailed DataLeak.................................................................................... 39
Help is Available................................................................... 3 Detailed DataPressure.............................................................................. 40
Getting Started with ResScan ............................................ 5 Detailed DataObstructive Apnea.............................................................. 41
Copying Data from PAP Device..................................................................... 6 Detailed DataCentral Apnea.................................................................... 42
Types of Available Data................................................................................ 7 Detailed Data for a Single Night: To Get to the Heart of the Therapy....... 43
Data Types Available by Device.................................................................... 8 High Resolution Data for a Single Night: Flow Curve................................ 44
Launch ResScan............................................................................................ 9 Oximetry............................................................................. 47
Data Card Download Option 1Quick Start Enabled.................................. 10 Oximetry Data............................................................................................. 48
Data Card Download Option 2Quick Start Disabled................................ 11 Detailed Data GraphsOximetry................................................................. 49
Create New Patient Record........................................................................ 12 Oximetry StatisticsOn Screen................................................................... 50
Open a Patient Record................................................................................ 13 Detailed Data with S9 Oximetry................................................................ 51
Download DataSelect Data Type.............................................................. 14 Notes and Device Log................................................................................. 53
Download Options...................................................................................... 15
Download DataStart Download............................................................... 16 Case Studies...................................................................... 55
Download Complete................................................................................... 17 Case Study 1: High LeakMouth Leaks Suspected.................................... 56
ResScan...................................................................................................... 18 Case Study 2: Low Therapy UsageIncrease Humidification
First 30 Days Viewing Range...................................................................... 19 or Introduce ResMed ClimateLine....................................... 60
First 30 Days Statistics............................................................................... 20 Case Study 3: High AHISuspected CSR.................................................... 62
Compliance Report Ready to Print.............................................................. 21 Case Study 4: Noncompliant Patient.......................................................... 64
Sample First 30 Days Report...................................................................... 22 Case Study 5: Compliant Patient................................................................ 66
Compliance Not Met................................................................................... 23 Case Study 6: Compliant Patient But Having Issues.................................. 68
Noncompliant Patient................................................................................. 24 Case Study 7: Patient Placed on S9 VPAP Adapt....................................... 69
Report CustomizationDefault Report Templates...................................... 25 Terminology & Definitions................................................ 71
Customize Existing or Create New Template............................................. 26 Therapy Device Mechanics......................................................................... 72
Customize Report Template........................................................................ 27 Flow Diagram.............................................................................................. 73
ResScan Interpretation..................................................... 31 CSA DetectorForced Oscillation Technique.............................................. 74
Statistical Data: Therapy Overview............................................................ 32 CSA Detector.............................................................................................. 75
Summary Data: How the Therapy Changed During the Time Period......... 33 CSA DetectorAutoSet Response.............................................................. 76
Select Detailed Graphs............................................................................... 34 Three Lines of Defense............................................................................... 77
Detailed GraphsSplit Screen.................................................................... 35 Glossary...................................................................................................... 78
Detailed Graphing OptionsSelect Traces.................................................. 36 ResMeds e-Learning Site................................................. 80
Detailed Graphing OptionsTime Period.................................................... 37
2 ResScan | Report Interpretation Guide
Help is Available
The Help button can be found
on the top of top tool bar.
The Help button provides
access to:
Users can search by keyword or
alphabetically within the index. Contact Us,
ResMed.com website
Comprehensive content library.
Hours
5:30 AM to 5:30 PM
(Pacific Time) Monday Friday
Phone
+1 (800) 424-0737, Option 6
Email
TechSupportUSA@resmed.com
4 ResScan | Report Interpretation Guide
ResScan | Report Interpretation Guide 5
Getting Started
Getting Started
with ResScan
6 ResScan | Report Interpretation Guide
1 2
Insert card (if not already in device) The following message is briefly displayed
Reading SD card
3 4
Getting Started
Summary Data
Usage
Efficacy (eg, AHI, pressure, leak)
Detailed Data
Nightly profile data
Data Storage
Escape /
S9 Series Elite AutoSet VPAP Auto VPAP S VPAP ST VPAP Adapt
Escape Auto
Sleep report on screen (365 sessions)
Compliance and summary data on device (365 sessions)
Compliance and summary data on SD card (365 sessions)
Detailed data on SD card (30 sessions)
High resolution ow data on SD card (7 sessions)
High resolution pressure data on SD card (7 sessions)
ResScan Display
Escape /
S9 Series Elite AutoSet VPAP Auto VPAP S VPAP ST VPAP Adapt
Escape Auto
Statisitics
Summary Graphs
Detailed Graphs
Oximetry Statistics*
Oximetry Graphs*
Launch ResScan
Getting Started
Install the program from your browser or CD, then launch the program
from the newly created desktop shortcut or from Programs.
Software Support
Hours
5:30 AM to 5:30 PM
(Pacific Time) Monday Friday
Phone
+1 (800) 424-0737, Option 6
Email
TechSupportUSA@resmed.com
10 ResScan | Report Interpretation Guide
Getting Started
Create/open patient record
OR
Download data
12 ResScan | Report Interpretation Guide
Getting Started
Select Open patient from the ResScan
home page to open a patient file.
Download Options
Getting Started
Summary compliance & efficacy data
Download Complete
Getting Started
When the download is complete, click the Close button.
The data will now appear on the left side of the Review window.
18 ResScan | Report Interpretation Guide
ResScan
Getting Started
Getting Started
When First 30 Days is chosen, software will automatically select
the first 30 days of compliance per Medicare guidelines.
20 ResScan | Report Interpretation Guide
Getting Started
22 ResScan | Report Interpretation Guide
Consecutive 30-day
period when compliance
was achieved.
Getting Started
Software will display warning message
24 ResScan | Report Interpretation Guide
Noncompliant Patient
Getting Started
Getting Started
There are several report templates automatically installed with
the ResScan software. Users are able to customize these default
templates, as well as create a new report template.
Click New to create a new report template Or select an existing report template to modify
Getting Started
Highlight field to Add to a section Highlight field to Remove a section
28 ResScan | Report Interpretation Guide
Getting Started
Delete a report template
Save the changes to the
report template
30 ResScan | Report Interpretation Guide
Interpretation
ResScan Interpretation
Provides clinical data analysis information to users
32 ResScan | Report Interpretation Guide
Device type and serial number Maximum Value: The highest value
reached during treatment.
Range of dates selected
95th percentile value: The value
Device mode and settings exceeded during the selected range
for 5% of the time. This value excludes
1 Compliance Data very high leak values which are not
always representative of actual
2 Unintentional leak clinical experience.
3 AHI, AI, CAI, OAI, HI Median Value: The median value re-
corded during the selected range. This
4 Pressure value minimizes the impact of extreme
values and is a better representation of
the group of values as a whole.
AHI, AI and HI: Number of events
per hour according to the event type
OAI: Obstructive apnea index
(upper airway closed)
CAI: Central apnea index
(upper airway open)
Unknown AI: Index of undetermined
apneas with large unintentional
leaks > 0.5 L/s (30 L/min).
ResScan | Report Interpretation Guide 33
Summary data: How the Therapy Changed During the Time Period
This is an example from a ResScan summary report.
Daily therapy usage with
therapy start and end times
DEFINITIONS
and pauses in therapy
Usage: Allows you to assess
patient compliance and identify
irregular usage.
Interpretation
Pressure: Allows you to identify
variations in pressure during the
Unintentional leak night, or from one night to the next.
Critical leak threshold Unintentional leak: The leak
is abnormally high if the 95th
> 24 L/min or 0.4 L/s
percentile is > 24L/min and/or
the median leak is high.
AHI, AI: Including the total
apnea index (AI in red) and
hypopnea index (HI in white).
Pressure
34 ResScan | Report Interpretation Guide
Interpretation
Hover cursor at the top edge
of desired graph to drag
36 ResScan | Report Interpretation Guide
Interpretation
Select time period in
order to hone in on
specific events
Unintentional leak
Leak threshold setting indicated
Interpretation
by red line
Events
Type of event (eg, central apnea)
and duration of event in seconds
(number at top of event line)
Detailed DataLeak
Single night
Looking for leak to be below 24 L/min over the course of the night
High leak may be affecting the accuracy of the data
Interpretation
Periods of leak > 24 L/min during the night
Detailed DataPressure
Pressure
Review pressure increases in response to events
Once the airway remains patent, the pressure begins to drop
Interpretation
ResScan | Report Interpretation Guide 41
Interpretation
Obstructive apnea event
(13 seconds)
Increase in pressure
13 second apnea
42 ResScan | Report Interpretation Guide
No pressure change
29 second apnea
ResScan | Report Interpretation Guide 43
Detailed Data for a Single Night: To Get to the Heart of the Therapy
Detailed data is available on
the past 30 days: Leak, event
types, flow limitation, snore
index, events, pressure and
minute ventilation, as well as
SpO2 and pulse rate.
Interpretation
In the inspiratory Flow
+ Limitation graph, the
taller the bar, the more
Note: The user can configure severe the limitation.
the layout of the graphs when
selecting a report.
In the Snore Index graph, the
+ taller the bar, the more severe
the snore.
Central Apnea:
Apnea with an open airway
Obstructive Apnea:
Interpretation
Apnea with a closed airway
Unknown Apnea:
Apnea that cannot be defined
because it occurs in the pres-
ence of high unintentional
leak (>0.5L/s or 30L/min)
Hypopnea:
Hypopnea associated with
flow limitation
Oximetry
Oximetry
48 ResScan | Report Interpretation Guide
Oximetry Data
Oximetry
SpO2% threshold line
50 ResScan | Report Interpretation Guide
SpO2
Pulse rate
ODI or oxygen
desaturation index
Oximetry
Oxygen desaturation index (ODI): Represents the average SpO2 and pulse rate
number of desaturations per hour. instantaneous values
displayed on the
The desaturation percentage can be set by the user in the
S9 screen
Options window in ResScan (default is 4%).
Oximetry
the tool bar, is only used with
the Stellar devices which
support ventilation.
Oximetry 54 ResScan | Report Interpretation Guide
ResScan | Report Interpretation Guide 55
Case Studies
Case Studies
56 ResScan | Report Interpretation Guide
Case Study 1:
High leakmouth
leaks suspected
Patient treated on S9 AutoSet with
a nasal mask. He is complaining of
a dry mouth.
1
1 The average usage is excellent:
5 hours 49 min.
Unintentional leak = Total leak Intentional leak from mask CO2 washout
In the presence of a high level of unin- You have to set the mask type (default is nasal).
tentional leak, the AHI value cannot be
analyzed correctly. First, you need to
solve the leak issue.
ResScan | Report Interpretation Guide 57
Case Study 1:
Suggested Solution
Adding a humidifier can help to
reduce nasal resistance and decrease
The summary data shows variable mouth leak.
leak levels over the first few days,
Replace the nasal mask with a
with a marked increase in leaks
ResMed full face mask if the leaks
in the days following.
persist.
Case Studies
and their characteristic plateau shape
(steep rise, flattening off then returning
to the base line) indicate the presence
of significant and variable leaks,
most likely mouth leaks.
58 ResScan | Report Interpretation Guide
Case Studies
60 ResScan | Report Interpretation Guide
Case Study 2:
Low therapy usage
Increase humidification
or introduce ResMed
ClimateLine
The patient has recently been given
an S9 AutoSet, but doesnt use it
very often. The patient also says that
he feels very thirsty when he wakes
up each morning.
4 The therapy pressure at the 95th percentile ResMed ClimateLine was added and
the device settings were not changed.
is 7.8 cm H2O with a maximum pressure
setting of 20 cm H2O.
ResScan | Report Interpretation Guide 61
Case Study 2:
Suggested Solution
The summary data graph clearly shows Add a ClimateLine to make therapy
the change in compliance after the more comfortable.
ClimateLine was introduced. Result: Adding a ClimateLine led to a
ClimateLine added significant increase in compliance. The
patient finds therapy more comfortable
and has increased utilization.
Case Studies
62 ResScan | Report Interpretation Guide
Case Study 3:
High AHIsuspected CSR
Patient treated on S9 AutoSet
with a high AHI.
We can observe:
Case Study 3:
Suggested Solution
Perform a sleep study
to check for CheyneStokes
respiration (CSR).
Case Studies
A flow curve pattern indicative of
Pressure, unintentional leak, flow limitation and events graphs are displayed CheyneStokes respiration
with a 2-hour time scale.
Case Study 4:
Noncompliant Patient
Low Usage
Case Studies
ResScan | Report Interpretation Guide 65
Case Study 4:
Noncompliant Patient
Summary Graphs
Case Studies
66 ResScan | Report Interpretation Guide
Case Study 5:
Compliant Patient
High Usage
Case Studies
ResScan | Report Interpretation Guide 67
Case Study 5:
Compliant Patient
Case Studies
68 ResScan | Report Interpretation Guide
Case Study 6:
Compliant patient
but having issues
Patient presently on VPAP
III S mode, IPAP 24, EPEP
20. Patient struggling
with therapy due to high
pressure, leak issues and
complaints of high respira-
tory rate. AHI is controlled
but feels like breathing on
the device is very hard
work. However, patient is
still wearing it almost
6 hours per night.
Leak issues
ResScan | Report Interpretation Guide 69
Case Study 7:
Patient placed
on S9 VPAP Adapt
Due to patient complaints,
patient underwent sev-
eral PSGs which revealed
central apneas. Titrated on
S9 VPAP Adapt, patient was
sent home on it. Patient im-
mediately felt a difference.
He stated it was more
AHI well comfortable and he could
controlled sleep more easily. Wore
device longer (30 mins) and
noticed decrease in pres-
sure from 24/20 to Ipap of
14.8. Resp rate changed
from 35 to 20.
This patient had been on the Vpap III for years. Always struggled but stuck with it. Complained that he could only tolerate the device
Case Studies
for about 3-4 hours per session, then would have to take the mask off to take a break. Could not tolerate the high pressures.
In previous sleep studies he ended up on 25/20, and had many centrals in the lab study.
In his Adapt study, he went to sleep on the device with a Quattro FX within 20 mins. Slept soundly all night; had no centrals at all.
After the EEP was increased to 8 cm, patient had no events or arousals. Got up wanting the device to be set up that day. He remarked
he had not slept that well for a long time. Patient was set up a week later on the device.
Case Studies 70 ResScan | Report Interpretation Guide
ResScan | Report Interpretation Guide 71
Records:
Enhanced AutoSet algorithm Flow-time curve
(central apnea detection) Snore
Apnea
Measurement of pressure
at the mask
Measurement of flow
ResScan | Report Interpretation Guide 73
Flow Diagram
FLOW
FLOW
FLOW
TIME TIME TIME TIME
Unrestricted inspiratory flow Flattened inspiratory flow time curve Snore superimposed on inspiratory Absence of flow (>10sec) = apnea
time curve denoting narrowed airway flow time curve
PRESSURE RESPONSE
PRESSURE
PRESSURE
PRESSURE
PRESSURE
TIME TIME TIME TIME
Pressure unchanged Pressure increased based on degree Pressure increased based on snore. Pressure increased at
of flattening. Flow limitation produces Louder snore produces faster rise. termination of apnea
a fine adjustment.
74 ResScan | Report Interpretation Guide
10 seconds
Respiratory Flow
4 seconds 6 seconds
CSA Detector
20
10
Apnea (O) Apnea (C) Apnea (C) Apnea (O) Apnea (O) Apnea (C) Apnea (O) Apnea (O)
ResScan | Report Interpretation Guide 77
FLOW
FLOW
FLOW
FLOW
FLOW
Normal
Normal Normal
FLOW
FLOW
FLOW
Partially
Partially Partially
Obstructed
Obstructed Obstructed Little or no
TIMETIME TIMETIME TIME
vibration TIMETIME TIME TIME
78 ResScan | Report Interpretation Guide
Glossary
Apnea AI: Apnea Index Median Daily Usage
The temporary absence or cessation of breathing. The middle value for daily usage, where values
An apnea is scored when there is reduction in HI: Hypopnea Index for Daily Usage are listed from low to high, over
breathing by 75% of the baseline breathing for CAI: Central Apnea Index a selected time period. While a few exceptionally
at least 10 seconds. ResScan shows three types high or low values can have a significant influence
Terminology & Definitions
of apneas: OAI: Obstructive Apnea Index on an average measure, the median is typically
UAI: Unknown Apnea Index more reflective of the true central tendency.
Central Apnea
An apnea during which the upper airway Average Event
remains open. A calculated value of a set of numbers computed by The occurrence of an apnea or a hypopnea. Events
adding the total number of values and dividing by are recorded as they occur. The maximum number
Obstructive Apnea of events stored per session is 500. After 500th
An apnea during which there is a physical the number of values. Average for usage (therapy)
hours is calculated over total calendar days. event, 501 replaces 500, 502 replaces 501, etc.
closing of the upper airway.
Daily Usage Flow
Unknown Apnea An estimate of the patients airflow during
An apnea during which a leak higher than Daily Usage is the total usage in a single session
(a session starts at midday and finishes 24 hours inspiration and expiration. It is derived by taking
30 L/min occurs, precluding accurate determi- the total flow and removing the leak and mask
nation of whether the apnea is obstructive later).
vent flow components.
or central. Average Daily Usage
Average daily usage is the result of the sum of Flow Limitation
Apnea Indices A measure of partial upper airway obstruction. This
For all indices, the value shown for Statistics is the Daily Usage divided by Used Days, over a selected
time period. measure is based on the shape of the inspiratory
total number of events divided by the Daily Usage. flowtime curve. A flattening of the inspiratory
AHI (ApneaHypopnea Index) Median flowtime curve suggests upper airway obstruction.
The total number of events is calculated by adding The middle number in a sorted list of numbers. A normal inspiratory curve would be round shaped.
the number of apneas and hypopneas events. For Half the numbers in the list are less, and half the
the AHI graph, the AHI count is incremented numbers are greater (Example: 3, 3, 4, 5, 5, 5, 6, 9,
whenever an event occurs and reset every hour. 12, 23, 48: median = 5). Median for usage (therapy)
hours is calculated over days used.
ResScan | Report Interpretation Guide 79
Glossary
Forced Oscillation Technique (FOT) Pulse Rate Used Days
A technique that applies small oscillations in The number of heartbeats in a 60-second The total number of days during which daily
pressure (1 cm peak-to-peak) at 4Hz, and analyzes time frame. The pulse rate is calculated by usage exceeded the compliance threshold
the pressure/flow response of this signal at the an attached oximeter. (X hours Y minutes).
mask. FOT detects whether the airway is
ResMed Corp San Diego, CA, USA +1 858 836 5000 or 1 800 424 0737 (toll free). ResMed Ltd Bella Vista, NSW, Australia +61 (2) 8884 1000 or 1 800 658 189 (toll free). See ResMed.com for other ResMed locations worldwide. ResScan, S9 AutoSet,
S9 Elite, S9 Escape, S9 Escape Auto, Ultra Mirage and VPAP Auto are trademarks of ResMed Ltd. AutoSet, ClimateLine, Escape, Mirage, S9, Stellar and VPAP are trademarks of ResMed Ltd and are registered in the U.S. Patent and Trademark Office.
2011 ResMed. Specifications may change without notice. 1014845/1 11 07