Scoring Respiratory Events

Presented by: Lisa Garvey, CRT; RPSGT Scoring Supervisor, WellNecessities

AASM Rules--Marking Events

For scoring either an Apnea or Hypopnea, the event duration is measured from the Nadir preceding the 1st breath that is clearly reduced to the beginning of the 1st breath that approximates the baseline breathing amplitude The sensor to detect absence of airflow for ID of an apnea is an oronasal thermal sensor The sensor for detection of airflow for ID of Hypopnea is a Nasal air pressure transducer (this also covers RERA scoring)
(source: AASM Manual for Scoring Sleep, 2007)

AASM Event Marking Rules--Apneas

Score Apnea when all of the following criteria met: Drop in peak Thermal sensor excursion by > 90% of pre-event baseline At least 90% of duration meets amplitude reduction criteria for apnea Duration: at least 10 seconds

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Obstructive Apnea
Defined as cessation in airflow for at least 10 seconds, with continued Respiratory effort, SpO2 desaturation, &/or EEG arousal. Sometimes arousal at the end of the event will be accompanied by leg jerks, & breakthrough snorts, & sometimes complete awakenings. If no respiratory effort occurs, it is NOT an OSA.

OSA Example

Mixed Apnea
Score

event as Mixed apnea if it meets apnea criteria & is associated with absent respiratory effort during initial part of event, followed by resumption of respiratory effort in latter part of event

Mixed Apnea

CSA

Score event as a Central Apnea if it meets Apnea criteria, & is associated with absent respiratory effort throughout entire period of absent airflow

CSA

AASM Hypopnea Rules 4-A & 4-B

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Rule 4-A: Score Hypopnea if: Nasal pressure signal drops by > 30% of baseline Duration of this drop occurs for at least 10 sec There is a > 4% desaturation from pre-event baseline At least 90% of events duration must meet amplitude criteria for Hypopnea

WellNecessities uses AASM Rule 4-A on all studies

AASM Hypopnea Rules cotd

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Rule 4-B: Score Hypopnea if all of the following criteria are met: Nasal Pressure signal excursion drops by > 50% of baseline Duration of this drop occurs for at least 10 sec Theres a > 3% desaturation from pre-event baseline OR event is associated with arousal At least 90% of events duration meets amplitude reduction criteria for hypopnea

RERAs

Respiratory Effort-Related Arousal

Score RERA if there is a sequence of breaths lasting at least 10 seconds, characterized by increasing resp. effort or flattening of NPT waveform leading to an Arousal from sleep when the sequence of breaths does not meet criteria for an apnea or hypopnea
Source: AASM Manual for the Scoring of Sleep & Assoc. Events, 2007

In Summary

Sensor for Apneasoronasal thermal sensor Sensor for HypopneasNasal Pressure Transducer Event duration must be no less than 10 seconds WellNecessities uses AASM Hypopnea Rule 4-A In additon to airflow sensors, use respiratory belts & EEG arousals to help you determine the beginning & end of an event. ID of any type of Apnea does NOT require a minimum desaturation criterion. Accurate event marking is imperative for a quality sleep study.