Respiratory Inductance Plethysmography Bands Research Articles

Validation of Tracheal Sound-Based Respiratory Effort Monitoring for Obstructive Sleep Apnoea Diagnosis.

Background: Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient's natural sleep. This study examines the reliability of an unobtrusive tracheal sound-based approach to monitor respiratory effort in the context of OSA, using manually marked respiratory inductance plethysmography (RIP) signals as a gold standard for validation. Methods: In total, 150 patients were trained on the use of type III cardiorespiratory polygraphy, which they took to use at home, alongside a neck-worn AcuPebble system. The respiratory effort channels obtained from the tracheal sound recordings were compared to the effort measured by the RIP bands during automatic and manual marking experiments. A total of 133 central apnoeas, 218 obstructive apnoeas, 263 obstructive hypopneas, and 270 normal breathing randomly selected segments were shuffled and blindly marked by a Registered Polysomnographic Technologist (RPSGT) in both types of channels. The RIP signals had previously also been independently marked by another expert clinician in the context of diagnosing those patients, and without access to the effort channel of AcuPebble. The classification achieved with the acoustically obtained effort was assessed with statistical metrics and the average amplitude distributions per respiratory event type for each of the different channels were also studied to assess the overlap between event types. Results: The performance of the acoustic effort channel was evaluated for the events where both scorers were in agreement in the marking of the gold standard reference channel, showing an average sensitivity of 90.5%, a specificity of 98.6%, and an accuracy of 96.8% against the reference standard with blind expert marking. In addition, a comparison using the Embla Remlogic 4.0 automatic software of the reference standard for classification, as opposed to the expert marking, showed that the acoustic channels outperformed the RIP channels (acoustic sensitivity: 71.9%; acoustic specificity: 97.2%; RIP sensitivity: 70.1%; RIP specificity: 76.1%). The amplitude trends across different event types also showed that the acoustic channels exhibited a better differentiation between the amplitude distributions of different event types, which can help when doing manual interpretation. Conclusions: The results prove that the acoustically obtained effort channel extracted using AcuPebble is an accurate, reliable, and more patient-friendly alternative to RIP in the context of OSA.

Methods for home-based self-applied polysomnography: the Multicenter AIDS Cohort Study.

Study ObjectivesAlong with multiple chronic comorbidities, sleep disorders are prevalent in people living with human immunodeficiency virus (HIV) infection. The goal of this study was to establish methods for assessing sleep quality and breathing-related disorders using self-applied home polysomnography in people with and without HIV.MethodsSelf-applied polysomnography was conducted on 960 participants in the Multicenter AIDS Cohort Study (MACS) using the Nox A1 recorder to collect data on the frontal electroencephalogram (EEG), bilateral electrooculograms, and a frontalis electromyogram during sleep. Breathing patterns were characterized using respiratory inductance plethysmography bands and pulse oximetry. Continuous recordings of the electrocardiogram were also obtained. All studies were scored centrally for sleep stages and disordered breathing events.ResultsSuccessful home polysomnography was obtained in 807 of 960 participants on the first attempt and 44 participants on the second. Thus, a successful polysomnogram was obtained in 851 (88.6%) of the participants. Reasons for an unsuccessful study included less than 3 h of data on oximetry (34.6%), EEG (28.4%), respiratory inductance plethysmography (21.0%), or two or more of these combined (16.0%). Of the successful studies (N = 851), signal quality was rated as good, very good, or excellent in 810 (95.2%). No temporal trends in study quality were noted. Independent correlates of an unsuccessful study included black race, current smoking, and cocaine use.ConclusionsHome polysomnography was successfully completed in the MACS demonstrating its feasibility in a community cohort. Given the burden of in-lab polysomnography, the methods described herein provide a cost-effective alternative for collecting sleep data in the home.

Impact of Vocal Effort on Respiratory and Articulatory Kinematics

Purpose: The goal of this study was to examine the effects of increases in vocal effort, without changing speech intensity, on respiratory and articulatory kinematics in young adults with typical voices. Method: A total of 10 participants completed a reading task under three speaking conditions: baseline, mild vocal effort, and maximum vocal effort. Respiratory inductance plethysmography bands around the chest and abdomen were used to estimate lung volumes during speech, and sensor coils for electromagnetic articulography were used to transduce articulatory movements, resulting in the following outcome measures: lung volume at speech initiation (LVSI) and at speech termination (LVST), articulatory kinematic vowel space (AKVS) of two points on the tongue dorsum (body and blade), and lip aperture. Results: With increases in vocal effort, and no statistical changes in speech intensity, speakers showed: (a) no statistically significant differences in LVST, (b) statistically significant increases in LVSI, (c) no statistically significant differences in AKVS measures, and (d) statistically significant reductions in lip aperture. Conclusions: Speakers with typical voices exhibited larger lung volumes at speech initiation during increases in vocal effort, paired with reduced lip displacements. To our knowledge, this is the first study to demonstrate evidence that articulatory kinematics are impacted by modulations in vocal effort. However, the mechanisms underlying vocal effort may differ between speakers with and without voice disorders. Thus, future work should examine the relationship between articulatory kinematics, respiratory kinematics, and laryngeal-level changes during vocal effort in speakers with and without voice disorders. Supplemental Material: https://doi.org/10.23641/asha.17065457

High Breath-by-Breath Variability Is Associated With Extubation Failure in Children.

Extubation failure is multifactorial, and most tools to assess extubation readiness only evaluate snapshots of patient physiology. Understanding variability in respiratory variables may provide additional information to inform extubation readiness assessments. Secondary analysis of prospectively collected physiologic data of children just prior to extubation during a spontaneous breathing trial. Physiologic data were cleaned to provide 40 consecutive breaths and calculate variability terms, coefficient of variation and autocorrelation, in commonly used respiratory variables (i.e., tidal volume, minute ventilation, and respiratory rate). Other clinical variables included diagnostic and demographic data, median values of respiratory variables during spontaneous breathing trials, and the change in airway pressure during an occlusion maneuver to measure respiratory muscle strength (maximal change in airway pressure generated during airway occlusion [PiMax]). Multivariable models evaluated independent associations with reintubation and prolonged use of noninvasive respiratory support after extubation. Acute care, children's hospital. Children were included from the pediatric and cardiothoracic ICUs who were greater than 37 weeks gestational age up to and including 18 years who were intubated greater than or equal to 12 hours with planned extubation. We excluded children who had a contraindication to an esophageal catheter or respiratory inductance plethysmography bands. Noninterventional study. A total of 371 children were included, 32 of them were reintubated. Many variability terms were associated with reintubation, including coefficient of variation and autocorrelation of the respiratory rate. After controlling for confounding variables such as age and neurologic diagnosis, both coefficient of variation of respiratory rate(p < 0.001) and low PiMax (p = 0.002) retained an independent association with reintubation. Children with either low PiMax or high coefficient of variation of respiratory rate had a nearly three-fold higher risk of extubation failure, and when these children developed postextubation upper airway obstruction, reintubation rates were greater than 30%. High respiratory variability during spontaneous breathing trials is independently associated with extubation failure in children, with very high rates of extubation failure when these children develop postextubation upper airway obstruction.

Unconstrained Detection of the Respiratory Motions of Chest and Abdomen in Different Lying Positions Using a Flexible Tactile Sensor Array

Respiratory Inductance Plethysmography (RIP) is commonly used to detect the respiratory motions of chest and abdomen during sleep. However, this method is not suitable for daily use due to its strong constraints. Many unconstrained methods have been developed, but they have a common problem with distinguishing the chest and abdominal motions, which are required for understanding the type of sleep apnea. In this paper, we proposed an unconstrained method to distinguish chest and abdominal motions by measuring the pressure fluctuations from the chest and abdomen acting on a mattress. We then investigated the feasibility of detecting respiratory motions by using a flexible tactile sensor array, which was laid on a bed like a bed sheet. Ten healthy subjects (five males and five females) were tested and the results were compared with those measured by the RIP band sensors. It was confirmed that the sensor array could measure the motions of the chest and abdomen and obtain the respiratory rate at a high accuracy. However, the phase of the pressure fluctuations measured by the sensor array might disagree with the outputs of the RIP band sensors, depending on the gender and lying position of the subject. The reason was discussed with a dynamic model, which showed that the disagreement might have been related to the coupling of the chest and abdomen. In addition, the influence of the stiffness of the mattress on the pressure fluctuations was investigated. The results showed that mattress stiffness had little effect on the measurement.

Development and validation of an algorithm for the study of sleep using a biometric shirt in young healthy adults.

Portable polysomnography is often too complex and encumbering for recording sleep at home. We recorded sleep using a biometric shirt (electrocardiogram sensors, respiratory inductance plethysmography bands and an accelerometer) in 21 healthy young adults recorded in a sleep laboratory for two consecutive nights, together with standard polysomnography. Polysomnographic recordings were scored using standard methods. An algorithm was developed to classify the biometric shirt recordings into rapid eye movement sleep, non-rapid eye movement sleep and wake. The algorithm was based on breathing rate and heart rate variability, body movement, and included a correction for sleep onset and offset. The overall mean percentage of agreement between the two sets of recordings was 77.4%; when non-rapid eye movement and rapid eye movement sleep epochs were grouped together, it increased to 90.8%. The overall kappa coefficient was 0.53. Five of the seven sleep variables were significantly correlated. The findings of this pilot study indicate that this simple portable system could be used to estimate the general sleep pattern of young healthy adults.

Breath detection by transcutaneous electromyography of the diaphragm and the Graseby capsule in preterm infants.

To compare triggering, breath detection and delay time of the Graseby capsule (GC) and transcutaneous electromyography of the diaphragm (dEMG) in spontaneous breathing preterm infants. In this observational study, a 30 minutes respiration measurement was conducted by respiratory inductance plethysmography (RIP), the GC, and dEMG in stable preterm infants. Triggering was investigated with an in vitro set-up using the Infant Flow® SiPAPTM system. The possibility to optimize breath detection was tested by developing new algorithms with the abdominal RIP band (RIPAB ) as gold standard. In a subset of breaths, the delay time was calculated between the inspiratory onset in the RIPAB signal and in the GC and dEMG signal. Fifteen preterm infants with a mean gestational age of 28 ± 2 weeks and a mean birth weight of 1086 ± 317 g were included. In total, 14 773 breaths were analyzed. Based on the GC and dEMG signal, the Infant Flow® SiPAP™ system, respectively, triggered 67.8% and 62.6% of the breaths. Breath detection was improved to 99.9% for the GC and 113.4% for dEMG in new algorithms. In 1492 stable breaths, the median delay time of inspiratory onset detection was +154 ms (IQR +118 to +164) in the GC and -50 ms (IQR -90 to -22) in the dEMG signal. Breath detection using the GC can be improved by optimizing the algorithm. Transcutaneous dEMG provides similar breath detection but with the advantage of detecting the onset of inspiration earlier than the GC.

PneuRIPTM: A Novel Respiratory Inductance Plethysmography Monitor.

Objective pulmonary function (PF) evaluation is essential for the diagnosis, monitoring, and management of many pediatric respiratory diseases as seen in the emergency room, intensive care, and outpatient settings. In this paper, the development and testing of a new noninvasive PF instrument, pneuRIPTM, which utilizes respiratory inductance plethysmography (RIP) are discussed. The pneuRIPTM hardware includes a small circuit board that connects to the RIP bands and measures and wirelessly transmits the band inductance data to any designated wirelessly connected tablet. The software provides indices of respiratory work presented instantaneously in a user-friendly graphical user interface on the tablet. The system was tested with ten normal children and compared with an existing system, Respitrace (Sensormedics, Yorba Linda, CA), under normal and loaded breathing conditions. Under normal breathing, the percentage differences between the two systems were 2.9% for labored breathing index (LBI), 31.8% for phase angle (Φ), 4.8% for percentage rib cage (RC%), and 26.7% for respiratory rate (BPM). Under loaded breathing, the percentage differences between the two systems were 1.6% for LBI, 4.1% for Φ, 8.5% for RC%, and 52.7% for BPM. For LBI, Φ, and RC%, the two systems were in general agreement. For BPM the pneuRIPTM is shown to be more accurate than the respitrace when compared to manually counting the breaths: 13.2% versus 36.4% accuracy for normal breathing and 16.9% versus 60.7% accuracy for breathing under load, respectively.

Long-term tolerability of capnography and respiratory inductance plethysmography for respiratory monitoring in pediatric patients treated with patient-controlled analgesia.

The Anesthesia Patient Safety Foundation has advocated the use of continuous electronic monitoring of oxygenation and ventilation to preemptively identify opioid-induced respiratory depression. In adults, capnography is the gold standard in respiratory monitoring. An alternative technique used in sleep laboratories is respiratory inductance plethysmography (RIP). However, it is not known if either monitor is well tolerated by pediatric patients for prolonged periods of time. The goal of this study was to determine whether capnography or RIP is better tolerated in nonintubated, spontaneously breathing pediatric patients being treated with intravenous patient-controlled analgesia (IVPCA). Nasal cannula capnography with oral sampling and thoracic and abdominal inductance plethysmography bands were placed along with the routine monitors on pediatric patients being treated for acute pain with IVPCA. Study monitors were left in place for as long as they were tolerated by the patient, up to a maximum of 24 consecutive hours. If the patient did not wear a particular study monitor for any reason, but tolerated the remaining monitor, participation in the study continued. If the patient would not wear either monitor, participation was terminated. Twenty-six patients (18 female, eight male, average age 10.1 ± 5.5 years) consented to participate, but only 14 patients attempted to wear one or both the devices. Among those who wore either device, median time to device removal was 8.33 h (range 0.3-23.6 h) for capnography and 23.5 h (range 0.7-24 h) for RIP bands. Children did not tolerate wearing capnography cannulae for prolonged periods of time, limiting the usefulness of this device as a continuous monitor of ventilation in children. RIP bands were better tolerated; however, they require further assessment of their utility. Until more effective, child-friendly monitors are developed and their utility is validated, guidelines recommended for adult patients cannot be extended to children.

Telemetric analysis of breathing pattern variability in recurrent airway obstruction (heaves)-affeeted horses

To use noninvasive respiratory inductance plethysmography (RIP) to investigate differences in breathing patterns between horses with and without recurrent airway obstruction (RAO) during the onset of airway obstruction induced through confinement to stables. 12 horses with no history or clinical signs of respiratory disease (control horses) and 7 RAO-affected horses. The study involved 2 phases. In phase 1, the optimal position of RIP bands for recording pulmonary function was investigated in 12 control horses. In phase 2, 7 RAO-affected and 7 control horses were confined to stables. Respiratory inductance plethysmography bands were applied to horses for 24 h/d to record respiratory rate and total displacement in 4-hour periods for 7 days or until RAO-affected horses developed signs of severe RAO that persisted for 2 consecutive days. Lung function was measured once daily. In phase 1, thoracic and abdominal cavity displacements were best represented by RIP bands positioned at intercostal spaces 6 and 17, respectively. In phase 2, pulmonary function indicated airway obstruction in the RAO-affected group on the final 2 days of stable confinement. Respiratory rate and total degree of respiratory displacement measured by RIP did not differ between the RAO-affected and control groups, but the SDs of these decreased significantly within 8 hours after stable confinement began in RAO-affected horses. Respiratory inductance plethysmography and pulmonary function findings became highly correlated as severity of disease progressed. The decrease in the SDs of RIP measurements indicated a lower degree of variability in breathing patterns of RAO-affected horses. This loss of variability may provide an early indicator of airway inflammation.

Development and Preliminary Validation of Heart Rate and Breathing Rate Detection Using a Passive, Ballistocardiography-Based Sleep Monitoring System

Techniques such as ballistocardiography (BCG) that can provide noninvasive long-term physiological monitoring have gained interest due to a growing recognition of adverse effects from poor sleep and sleep disorders. The noninvasive analysis of physiological signals (NAPS) system is a BCG-based monitoring system developed to measure heart rate, breathing rate, and musculoskeletal movement that shows promise as a general sleep analysis tool. Overnight sleep studies were conducted on 40 healthy subjects during a clinical trial at the University of Virginia. The NAPS system's measures of heart rate and breathing rate were compared to ECG, pulse oximetry, and respiratory inductance plethysmography (RIP). The subjects were split into a training dataset and a validation dataset, maintaining similar demographics in each set. The NAPS system accurately detected heart rate, averaged over the prescribed 30-s epochs, to within less than 2.72 beats per minute of ECG, and accurately detected breathing rate, averaged over the same epochs, to within 2.10 breaths per minute of RIP bands used in polysomnography.

Abnormal speech sound representation in persistent developmental stuttering

To determine whether adults with persistent developmental stuttering (PDS) have auditory perceptual deficits. The authors compared the mismatch negativity (MMN) event-related brain potential elicited to simple tone (frequency and duration) and phonetic contrasts in a sample of PDS subjects with that recorded in a sample of paired fluent control subjects. Subjects with developmental stuttering had normal MMN to simple tone contrasts but a significant supratemporal left-lateralized enhancement of this electrophysiologic response to phonetic contrasts. In addition, the enhanced MMN correlated positively with speech disfluency as self-rated by the subjects. Individuals with persistent developmental stuttering have abnormal permanent traces for speech sounds, and their abnormal speech sound representation may underlie their speech disorder. The link between abnormal speech neural traces of the auditory cortex and speech disfluency supports the relevance of speech perception mechanisms to speech production.