Test results or a summary?

I requested a copy of my sleep study results from my pulmonologist, and they faxed over a 1 page report - it includes a lot of the information I've seen referenced on here... but it seems less comprehensive than what I was expecting. Is whats below the entire thing... or is just just a summary?

Any comments or data interpretation on anything (including the parts I'm questioning) are welcome!

Lights out at 11:23pm and lights on at 6:17am

Sleep latency was 43.8 minutes and prolonged (what does the 'and prolonged' mean?)
REM latency was proglonged 260.3 minutes
Sleep efficiency was slightly reduced to 82.1%
Stage N1 was 18 min
Stage N2 was 147.5 minutes
Stage N3 was 77.5 minutes
Stage REM was 96.5 minutes

Diagnostic Study was 11:23pm until 2:22am
apnea/hypopne index of 124.9 events per hour
Apneas were 54
Hypopneas were 199
Respiratory event related arousals were 0 (but if I'm not waking up, why am I so tired???)
Oxygen saturation low was 71% and high was 92%

EKG normal sinus rhytham
No significant PLM arousals were noted

Impression:
Severe Obstructive Sleep Apnea
Snoring
Hypersomnia
Abnormal overnight pulse oximetry with hypoxia (is this as bad as it sounds?)

Chairman Meow wrote: Is whats below the entire thing... or is just just a summary? ...Sleep latency was 43.8 minutes and prolonged (what does the 'and prolonged' mean?) ...Respiratory event related arousals were 0 (but if I'm not waking up, why am I so tired???) ...Abnormal overnight pulse oximetry with hypoxia (is this as bad as it sounds?)

There is more information in the report. It's usually a few pages, and is a breakdown of the information you have. It includes things like sleep position and how many events happened in each position and sleep stage. "Prolonged" means longer than expected or beyond what is considered "normal". Yeah, it's bad. Seen others on here with worse numbers, but you certainly need treatment. Fortunately, effective CPAP treatment should turn all that around. Two things about your report stood out to me that you might want to ask your doctor about. You had significant amounts of all sleep stages, and no respiratory arousals. Is that a sign of sheer exhaustion, or is there an error on the respiratory arousals? Maybe someone else can speak to this - is this normal and I just don't see it often? The other thing is your report says there were no significant limb movement arousals. What exactly does that mean? How many limb movements and how many arousals were there? Just thought it odd to have any, yet no respiratory arousals. May not mean anything. but just caught my eye. Were those limb movements during the diagnostic or titration part of the night? Stay in touch as your treatment gets going. You'll likely end up with more questions. Hopefully those more knowledgeable than I about sleep reports will weigh in and be of more help.

I'll try to address your questions and give you a link that explains the sleep study results. This is from my understanding and I'm not an expert. But thought I might be able to help.

First your sleep latency is the time it takes you to fall asleep. I believe they consider 15 mins to be normal so yours is prolonged, which is not unusual for people with sleep disorders.

Second question, RERAs (respiratory event related arousals) are not apneas or hypopneas and a 0 there doesn't mean you aren't waking up with all your other apneas and hypopneas causing you to be tired.

Third question, you have severe sleep apnea and during those apneas you oxygen levels decreased with the lowest level being 71%.

Here is a link to help explain sleep studies. http://www.sleepapnea.org/treat/diagnos ... tails.html
This link defines different terminology. wiki/index.php/Category:CPAP_Definitions

Surely you did not receive the whole report.

Mine was 10 pages long and I think that is pretty typical.

Ask for the entire report. You are entitled to it under Federal Law.

With all my doctors, I have had the nice office staff staple a note to the front of my medical file stating:

Patient wants an entire page-by-page copy mailed to him of every medical report received in our office or prepared by our office.

Best wishes, Nate

Chairman Meow,

This looks like a summary data page. My own reports were in the neighborhood of about 3 pages long. Most of teh other pages were graphs that showed what was going on while I "slept".

To address your particular questions:

Chairman Meow wrote: Sleep latency was 43.8 minutes and prolonged (what does the 'and prolonged' mean?)
REM latency was proglonged 260.3 minutes
Sleep efficiency was slightly reduced to 82.1%
Stage N1 was 18 min
Stage N2 was 147.5 minutes
Stage N3 was 77.5 minutes
Stage REM was 96.5 minutes

This is the summary data about your sleep "architecture." Prolonged means "longer than average or expected".

It took you 43.8 minutes from the time they turned the lights out (and you started trying to go to sleep) until you actually fell asleep. You didn't get into your first REM sleep until 260.3 minutes after you fell asleep, and that too is longer that average---most people tend to hit that first REM cycle around 90 minutes after falling asleep.

The sleep stage numbers are how much time you spent in each stage. Given the numbers below about how long the Diagnostic part of your study lasted, it appears that these numbers include all of the sleep you got during the night---both during the Diagnostic part of the study and the titration part of the study.

During the time you were asleep, you were in N1 (a light, transitional sleep stage) for 18 minutes of the total time you were asleep. You were in N2 sleep for a total of 147.5 minutes. N3 sleep is deep non-REM sleep (sometimes called slow wave sleep), and you were in N3 for a total of 77.5 minutes. You were in REM sleep for 96.5 minutes. The average times spent in each stage of sleep varies a bit as we age, but typically an adult with normal sleep will spend around 20-25% of the night in REM and around 15-25% of the night in N3 as I recall. (The amount of time in N3 tends to decrease as we age.)

Diagnostic Study was 11:23pm until 2:22am
apnea/hypopne index of 124.9 events per hour
Apneas were 54
Hypopneas were 199
Respiratory event related arousals were 0 (but if I'm not waking up, why am I so tired???)
Oxygen saturation low was 71% and high was 92%

If the Diagnostic Study lasted from 11:23 to 2:22, you must have had a so-called split study.

An apnea is when no air is going into or out of your lungs for at least 10 seconds. In an obstructive apnea, the problem is that your airway has collapsed, but you are trying to breathe. A hypopnea occurs when your airway has partially collapsed: While some air continues to get into and out of the lungs, the amount of air flowing into the lungs has dropped by at least 50%, but you are trying to breathe in a normal amount of air.

During the time you were asleep during the three hours between 11:23 and 2:23, you experienced a total of 54 apneas and 199 hypopneas. Now remember that your sleep latency was 43.8 minutes. So at most you got 179-43.8=135.2 minutes of sleep. However, my guess is that you did have about 14-15 minutes of time in wake-after-sleep-onset (WASO) since your AHI = 124.9 = (54 + 199)/(total time asleep). Some basic arithmetic says that you were actually asleep for 2.03 hours, which is about 121.5 minutes.

A respiratory event related arousal (RERA) is most easily thought of as a "hypopnea wannabe"----there is evidence of increasing effort to breath, but it either doesn't last long enough to be scored as a hypopnea OR the decrease in air flow is not severe enough to be scored as a hypopnea. Hence, there is an identifiable respiratory event, but it's not quite "severe" enough to be scored as a hypopnea. And the event ends with an EEG arousal. Apneas and hypopneas often end with an arousal in the EEG, but those apnea and hypopnea related arousals are not scored as RERAs. Sometimes the summary data will also have a section on all the arousals that were recorded during the sleep study, and in that case, all the arousals that are related to RERAs, hypopneas, and apneas will added together and called "respiratory related arousals" and arousals due to other causes (such as periodic limb movements) will be totaled separately. Spontaneous arousals are arousals that don't seem to be related to anything.

It's important to understand that an EEG arousal is NOT the same as "waking up". An arousal is a sudden change in sleep stage from a deeper/REM state to a lighter state or all the way to WAKE. And while no RERAs were scored during the diagnostic part of your study, that doesn't mean there were no arousals or awakenings. It's just that the arousals and awakenings related to respiratory problems were related to the numerous hypopneas and apneas.

An AHI = 124.9 means that the average number of apneas+hypopneas per hour of sleep was 124.9 during the diagnostic part of the study. In other words, during the diagnostic part of the sleep study, you were experiencing an average of TWO apneas/hypopneas for every MINUTE of sleep. Since each apnea/hypopnea has to last at least 10 seconds, that means that for every MINUTE of sleep you are not breathing normally for at least 20 seconds. And some (most?) apneas and hypopneas last longer than the minimum 10 seconds needed to score them.

And in your case, the numerous hypopneas and apneas are leading to some pretty significant O2 desats: At some point (or points) in the diagnostic part of your test, your O2 saturation dropped as low as 71%. That's low enough to be pretty scary. (It would be useful to have the SaO2 graph to see how often your O2 levels were below 80%.) The fact that your maximum O2 saturation was only 92% also seems like it might be a concern.

No wonder you are exhausted in the morning: You're spending at least 1/3 of each night NOT breathing very well. And you are spending a significant fraction of the night with low O2 saturations as well.

EKG normal sinus rhytham
No significant PLM arousals were noted

These are GOOD news: You don't seem to have a significant problem with periodic limb movements creating problems with your sleep and there were no abnormal EKG readings from the heart monitor

Impression:
Severe Obstructive Sleep Apnea
Snoring
Hypersomnia
Abnormal overnight pulse oximetry with hypoxia (is this as bad as it sounds?)

An AHI > 30 is considered Severe OSA. Your AHI = 124.9 is four times higher than that. So your OSA is very severe. Snoring with that severe of OSA is no surprise. Hypersomnia simply means that you experience excessive sleepiness during the daytime and (probably) have trouble staying awake during the daytime.

The phrase "abnormal overnight pulse oximetry with hypoxia" means that the pulse oximetry numbers were substantially lower than where they are supposed to be. Some, maybe most or all, of the overnight hypoxia is probably directly related to the severe OSA. But if the O2 numbers during the titration part of the study didn't get above 92%, this phrase may indicate that something else may be going on and that while CPAP will treat the OSA, you may also need further diagnostic work to figure out what else might be leading to those low O2 saturation numbers when you are sleeping. It's possible that the doc who sees you to talk about these numbers may want to find out whether your daytime O2 levels are also very low.