Cyclic Alternating Pattern-gctid132

American Sleep Association Forums Technologists-gc38 Scoring-gc24 Cyclic Alternating Pattern-gctid132

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  • #13388

    peteRPSGT
    Member

    Is there anyone in this forum that comments on CAP in their reports? Can someone please explain the clinical significance of CAP and why I should comment on it?

    #13390

    sleepy
    Member

    Italics are mine.

    Obstructive sleep-disordered breathing with a dominant cyclic alternating pattern–a recognizable polysomnographic variant with practical clinical implications.Thomas RJ, Terzano MG, Parrino L, Weiss JW.
    Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass 02215, USA. rthomas1@bidmc.harvard.edu

    OBJECTIVES: To define the clinical and polysomnographic features of a distinct variant of obstructive sleep-disordered breathing that is remarkably mild during rapid eye movement (REM) sleep. DESIGN: Observational study and evaluation of polysomnographic and clinical records. SETTING: American Academy of Sleep Medicine-accredited multidisciplinary sleep disorders center and laboratory. PATIENTS: 35 medication-free subjects with clinical and polysomnographic severe obstructive sleep-disordered breathing selected for dominance of 1 of 2 disordered breathing patterns. INTERVENTIONS: Positive airway pressure titration. MEASUREMENTS AND RESULTS: Nasal pressure was used to score respiratory events. Sleep was scored by both the standard criteria and cyclic alternating pattern (CAP), and the distribution of respiratory events was tabulated and analyzed. A distinct clinical and polysomnographic syndrome emerged, CAP-dominant sleep-disordered breathing, characterized by severe relatively short cycle obstructive events during non-REM sleep that were mild in REM sleep. Characteristics include lower body mass index, fewer apneas, and a lower hypoxic burden as reflected by frequency and severity of nocturnal oxygen saturation. During positive pressure titration, a remarkable respiratory instability emerged selectively during CAP, in contrast to stability during REM sleep. This partial treatment failure was associated with persistent clinical symptoms. CONCLUSIONS: This variant of sleep apnea may reflect a dominant component of respiratory instability and periodic breathing coupled with upper-airway obstruction. Its existence questions the conventional practice of calculating global respiratory indexes. Besides positive airway pressure, measures to treat periodic breathing may be required.PMID: 15124715 [PubMed – indexed for MEDLINE]

    We chart CAP. It’s also seen w/Fibromyalgia. There may be a peds component but I’ve forgotten what it is…

    #13432

    peteRPSGT
    Member

    Thanks Sleepy – you are awesome

    "sleepy" wrote: Italics are mine.

    Obstructive sleep-disordered breathing with a dominant cyclic alternating pattern–a recognizable polysomnographic variant with practical clinical implications.Thomas RJ, Terzano MG, Parrino L, Weiss JW.
    Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass 02215, USA. rthomas1@bidmc.harvard.edu

    OBJECTIVES: To define the clinical and polysomnographic features of a distinct variant of obstructive sleep-disordered breathing that is remarkably mild during rapid eye movement (REM) sleep. DESIGN: Observational study and evaluation of polysomnographic and clinical records. SETTING: American Academy of Sleep Medicine-accredited multidisciplinary sleep disorders center and laboratory. PATIENTS: 35 medication-free subjects with clinical and polysomnographic severe obstructive sleep-disordered breathing selected for dominance of 1 of 2 disordered breathing patterns. INTERVENTIONS: Positive airway pressure titration. MEASUREMENTS AND RESULTS: Nasal pressure was used to score respiratory events. Sleep was scored by both the standard criteria and cyclic alternating pattern (CAP), and the distribution of respiratory events was tabulated and analyzed. A distinct clinical and polysomnographic syndrome emerged, CAP-dominant sleep-disordered breathing, characterized by severe relatively short cycle obstructive events during non-REM sleep that were mild in REM sleep. Characteristics include lower body mass index, fewer apneas, and a lower hypoxic burden as reflected by frequency and severity of nocturnal oxygen saturation. During positive pressure titration, a remarkable respiratory instability emerged selectively during CAP, in contrast to stability during REM sleep. This partial treatment failure was associated with persistent clinical symptoms. CONCLUSIONS: This variant of sleep apnea may reflect a dominant component of respiratory instability and periodic breathing coupled with upper-airway obstruction. Its existence questions the conventional practice of calculating global respiratory indexes. Besides positive airway pressure, measures to treat periodic breathing may be required.PMID: 15124715 [PubMed – indexed for MEDLINE]

    We chart CAP. It’s also seen w/Fibromyalgia. There may be a peds component but I’ve forgotten what it is…

    #13436

    sleepy
    Member

    😉

    #13494

    rafeekmk
    Member

    can any one make detailed comment on CAP?

    #13496

    sleepy
    Member

    What kind of detail are you looking for? Theres’s been alot published on the topic… the earlier post covers the basics pretty well, this one is tx oriented. (Italics mine)

    Sleep reactivity during acute nasal CPAP in obstructive sleep apnea syndrome.
    Parrino L, Smerieri A, Boselli M, Spaggiari MC, Terzano MG.
    Sleep Disorders Centre, Istituto di Neurologia, Università di Parma, Italy.

    OBJECTIVE: To measure the readjustments of sleep macro- and microstructure in patients with obstructive sleep apnea syndrome (OSAS) after acute nasal continuous positive airway pressure (NCPAP) treatment. BACKGROUND: The conventional polysomnographic analysis (macrostructure of sleep) does not necessarily provide the best measures of sleep disruption associated with OSAS. In contrast, microstructural methods of analyzing sleep (i.e., arousals and cyclic alternating pattern) may improve evaluation of patients with OSAS. Method:- Ten patients with OSAS were monitored polygraphically before and during the first night of NCPAP therapy. The results were compared with those of 10 age- and sex-matched controls without sleep-related breathing disorders. Each nocturnal recording was followed by daytime observation using the multiple sleep latency test and Visual Analogue Scale (VAS). RESULTS: The first night of ventilatory therapy was characterized by a remarkable expansion of stages 3 and 4 and of REM sleep. In addition, NCPAP suppressed the presence of cyclic alternating pattern (CAP) in REM sleep and induced an impressive rebound of arousals and of certain CAP variables-i.e., CAP rate, CAP time, number of CAP cycles-which dropped well below the physiologic values expressed by controls. A normal duration of phases A and B was re-established starting the first treatment night. When we matched sleep variables with the indices of daytime function, a significant correlation emerged only between the variations of CAP rate and VAS scores. In particular, improvement of daytime sleepiness was less evident when the ventilatory-induced drop of CAP rate was more pronounced. CONCLUSIONS: The application of CAP variables to the microstructural analysis of sleep may expand our knowledge regarding sleep and respiration.
    PMID: 10762505 [PubMed – indexed for MEDLINE]

    #13497

    ayisha
    Member

    "sleepy" wrote: Sleep was scored by both the standard criteria and cyclic alternating pattern (CAP), and the distribution of respiratory events was tabulated and analyzed.

    Hi

    i am new to the sleep field.

    i know to score sleep based on R&K,ASDA 1992 arousal scoring rules (i think it is what described as standard criteria).

    what is the criteria to score sleep with CAP?

    Sorry if my doubts are very basic 😳

    plzz help me

    #13514

    rafeekmk
    Member

    a good one

    http://www.aastweb.org/pdf/A2Z_2003_spring.PDF

    read from page 30

    "Cyclic alternating pattern

    A New way to look in to Sleep"

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