11/20/2015. Eighth Bi-Annual Pediatric Sleep Medicine Conference. November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida

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1 Eighth Bi-Annual Pediatric Sleep Medicine Conference November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida Carol L. Rosen, MD Case Western Reserve University School of Medicine Rainbow Babies & Children s Hospital Cleveland, OH Sponsored by The Warren Alpert Medical School of Brown University 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 B. Mixed apnea C. Obstructive apnea D. Obstructive hypopnea 1

2 B. Mixed apnea C. Obstructive apnea D. Obstructive hypopnea B. Central hypopnea C. Obstructive apnea D. Obstructive hypopnea in REM Hypopnea Inspiratory Breath Hold Tachypnea 41 Seconds in REM B. Central hypopnea C. Obstructive apnea -uber D. Obstructive hypopnea Bonus Q, another event? A. Achondroplasia B. Congenital central hypoventilation C. Prader-Willi D. Rett s Inspiratory Breath Hold Tachypnea 41 Seconds A. Achondroplasia B. Congenital central hypoventilation C. Prader-Willi D. Rett s Marcus CL et al. Polysomnographic characteristics of patients J Pediatr 1994;125: SpO2 average 97% with episodic desaturations EtCO2 values ~ 42 mmhg A. Central hypoventilation C. Heart failure 2

3 SpO2 average 97% with episodic desaturations EtCO2 values ~ 42 mmhg A. Central hypoventilation C. Heart failure A. Bruxism B. Load compensation C. Palatal myoclonus D. Snoring N3, 30 sec A. Bruxism B. Load compensation C. Palatal myoclonus D. Snoring N3, 30 sec SpO 2 averages 94% EtCO 2 average 35 mmhg #1 flow limitation #2 tachypnea; >50 breaths/min #3 SpO 2 94% Bonus question: is EtCO 2 reliable? why or why not? Not: likely underestimates because of tachypnea A. Oxygen B. PHOX2B C. Pulmonary referral D. Reassurance in N3 sleep SpO 2 mean 97% EtCO 2 mean 35 mmhg TcCO2 mean 41 mmhg = 35 breaths/min 3

4 Tachypnea ( -35/hr) with normal gas exchange A. Oxygen B. PHOX2B C. Pulmonary referral D. Reassurance in N3 sleep SpO 2 mean 97% EtCO 2 mean 35 mmhg TcCO2 mean 41 mmhg = 35 breaths/min A. Flow limitation B. Hyperventilation C. Obstructive hypoventilation D. Technical problem in N2 sleep SpO % EtCO 2 mean 25 mmhg No Pleth Waveform Bad Pleth: SpO % A. Flow limitation B. Hyperventilation C. Obstructive hypoventilation D. Technical problem in N2 sleep SpO % EtCO 2 mean 25 mmhg Good Pleth: SpO 2 98% 4

5 A. Normal breathing B. Obstructive hypoventilation C. Central hypoventilation D. Sleep-related hypoxemia in N3 sleep SpO 2 mean 96% EtCO 2 mean 54 mmhg A. Normal breathing B. Obstructive hypoventilation C. Central hypoventilation D. Sleep-related hypoxemia in N3 sleep SpO 2 mean 96% EtCO 2 mean 54 mmhg Snore/noise Snore/noise EtCO2 # 39 mmhg 40 mmhg 41 mmhg 38 mmhg 36 mmhg EtCO2 # 39 mmhg 40 mmhg 41 mmhg 38 mmhg 36 mmhg EtCO 2 wave EtCO 2 wave Airflow Airflow Chest effort Abd effort 10 sec Chest effort Abd effort 10 sec SpO2 100% 90% SpO2 100% 90% Desat to 84% Desat to 84% A. Cardiac evaluation B. CNS imaging C. CPAP titration D. PHOX2B testing 60 sec fragment A. Cardiac evaluation B. CNS imaging C. CPAP titration D. PHOX2B testing 60 sec fragment A. Anemia B. Abnormal hemoglobin C. Hydroxyurea therapy in N3 sleep SpO 2 mean 84% EtCO 2 mean 38 mmhg A. Anemia B. Abnormal hemoglobin C. Hydroxyurea therapy in N3 sleep SpO 2 mean 84% EtCO 2 mean 38 mmhg 5

6 A. Cheyne-Stokes respiration C. Central sleep apnea with hypoventilation in sleep SpO 2 mean 92% TcCO 2 61 mmhg A. Cheyne-Stokes respiration C. Central sleep apnea with hypoventilation in sleep SpO 2 mean 92% TcCO 2 61 mmhg A. Cardiogenic artifact B. Cell phone artifact C. Diaphragm flutter D. Panic attack in wake SpO 2 mean 98% EtCO mmhg A. Cardiogenic artifact B. Cell phone artifact C. Diaphragm flutter D. Panic attack in wake SpO 2 mean 98% EtCO mmhg Thank You carol.rosen@case.edu 6

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