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Respiratory state sequences for 102 patients who had a procedure in a cardiac catheterisation laboratory with procedural sedation and analgesia were developed by classifying each second of procedures into a state of normal breathing or other capnography waveform abnormalities based on pre-specified cut-offs for respiratory rate and end-tidal CO<jats:sub>2<\/jats:sub> concentration. Hierarchical clustering identified four common patterns in respiratory state sequences, which were characterized by a predominance of the state assigned normal breathing (n\u2009=\u200942; 41%), hypopneic hypoventilation (n\u2009=\u200938; 38%), apnea (n\u2009=\u200915; 15%) and bradypneic hypoventilation (n\u2009=\u20097; 7%). A multivariable distance matrix regression model including demographic and clinical variables explained 28% of the variation in inter-individual differences in respiratory state sequences. Obstructive sleep apnea (R<jats:sup>2<\/jats:sup>\u2009=\u20092.4%; p\u2009=\u20090.02), smoking status (R<jats:sup>2<\/jats:sup>\u2009=\u20092.8%; p\u2009=\u20090.01), Charlson comorbidity index score (R<jats:sup>2<\/jats:sup>\u2009=\u20092.5%; p\u2009=\u20090.021), peak transcutaneous carbon dioxide concentration (R<jats:sup>2<\/jats:sup>\u2009=\u20094.1%; p\u2009=\u20090.002) and receiving an intervention to support respiration (R<jats:sup>2<\/jats:sup>\u2009=\u20095.6%; p\u2009=\u20090.001) were significant covariates but each explained only small amounts of the variation in respiratory state sequences. Oxygen desaturation (SpO<jats:sub>2<\/jats:sub>\u2009&lt;\u200990%) was rare (n\u2009=\u20093; 3%) and not associated with respiratory state sequence trajectories.<\/jats:p>","DOI":"10.1038\/s41598-019-46751-2","type":"journal-article","created":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T10:50:58Z","timestamp":1563187858000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Sequence analysis of capnography waveform abnormalities during nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory"],"prefix":"10.1038","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9583-8636","authenticated-orcid":false,"given":"Aaron","family":"Conway","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Collins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8987-3427","authenticated-orcid":false,"given":"Kristina","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Mafeld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Sutherland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Fingleton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,7,15]]},"reference":[{"key":"46751_CR1","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1111\/jocn.12147","volume":"23","author":"A Conway","year":"2014","unstructured":"Conway, A., Rolley, J., Page, K. & Fulbrook, P. 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This study received funding from the Wesley Medical Research (Project number: 2015-31). J.S., K.C., P.C. & J.F. declare no potential competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"10214"}}