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OBSTRUCTIVE SLEEP APNOEA: CHEST WALL MOVEMENT AND HEART MONITORING
Chest wall movement: Obstructive and Central
The two broad categories of sleep apnoea, central and obstructive, are defined by the type of respiratory efforts made. One way of measuring this is to look at the movement of the chest wall as it expands and contracts with each breath, in conjunction with a detector of airflow at the opening of the nasal passage. When the upper airway collapses in obstructive sleep apnoea, the chest wall continues to move but there will be no detectable airflow through the nose. Falling oxygen levels stimulate the patient to take bigger breaths resulting in ever increasing signals from the monitor of chest wall movement. Eventually the obstruction is overcome, airflow is again detected and breathing returns to normal until the next obstructive event. With central apnoea, the chest wall shows little or no sign of movement, indicating an absence of respiratory effort. This is also accompanied by a cessation of airflow.
Heart monitoring
The final obligatory assault comes in the form of a heart monitor (or ECG), the electrodes of which are attached to the chest. The ECG records the heart rate and provides information about the electrical impulses which stimulate the heart to beat regularly.
The process of “wiring up” for a sleep study can be an intimidating experience for those with an innate fear of hospitals and high technology. A small percentage of patients never relax enough to get a good night’s sleep, but most adapt quickly to the novel circumstances and sleep soundly enough for the purpose of the investigation. In this respect, patients with advanced OSA have no problems, often falling asleep while being attached to their monitoring equipment.
The capacity to measure oxygen saturation, sleep states, chest wall movement, nasal airflow and heart rate is a minimum requirement for a unit specializing in sleep-related breathing disorders. Some units, however, are capable of measuring other parameters of sleep and breathing and have the resources to screen several patients on the same night.
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