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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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d.green
 
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How to read a sleep study test

Postby d.green on Sun Nov 23, 2008 3:03 pm

I had a sleep study test done back in August of this year. I was placed on a cpap at 9cm. I have have looked over the report today, and saw that it shows I had central instead of obstructive sleep apena during the whole test. But, I am being treated for obstructive and not central sleep apena. Is this how any sleep apena is treated?


Thanks

Dan

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Re: How to read a sleep study test

Postby Snoredog on Sun Nov 23, 2008 3:07 pm

Centrals sometimes go away after you go on CPAP. Some centrals are normal and appear when you transition from one stage of sleep to another and there is not much you can do about those.

DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.

Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%

Stage3&4, REM decrease as we age.


Stuff seen on a PSG Report:

Arousal: An interruption of sleep lasting greater than 3 seconds.

BR Arousal index: The number of breathing related arousals(apnea, hypopnea, snoring & RERAs)multiplied by the # hours of sleep.

Bruxism: Grinding of the teeth.

Central apnea: A respiratory episode where there is no airflow and no effort to breathe lasting greater than 10 seconds.

EEG/EOG: Comments about sleep stages, brain waves (EEG), or eye movements (EOG)

EKG/ECG: Comments about heart rate, abnormal heart beats, etc.

EMG: Comments about leg movements and or teeth grinding (bruxism).

Hypopnea: A respiratory episode where there is partial obstruction of the airway lasting greater than 10 seconds. Also called partial apnea or hypo-apnea.

Non-supine: Sleeping in any position other than on the back.

NSR: Normal sinus rhythm.

NPSG: Nocturnal Polysomnogram, or sleep study.

(#)Number of Awakenings: The number of pages scored as wake after sleep onset.

Obstructive apnea: A respiratory episode where there is a complete cessation of airflow lasting greater than 10 seconds.
PLMs: Periodic limb movements.

PLM arousal index: The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.

PSGT: Polysomnographic technologist.

REM latency: Latency to REM(dreaming) from sleep onset.

RERAs: Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.

Respiratory: Any specific comments about respiratory events.

RPSGT: Registered polysomnographic technologist.

Sleep efficiency: Total sleep time multiplied by time in bed.

Sleep latency: The first 30 seconds (one `epoch' of recording time) of sleep.

Sleep onset: The first 90 seconds (3 `epochs) of uninterrupted sleep.

Sleep stage shifts: The number of incidents of sleep stage changes.

Snoring intensity: Level of snoring loudness determined by the sleep technologist. Ranging in degrees from mild to very loud snoring.

Spontaneous arousal index: The number of spontaneous arousals (e.g. arousals not related to respiratory events, limb movements, snoring, etc) multiplied by the number of hours of sleep.

Stage 1: The lightest stage of sleep. Transitional stage from wake. top

Stage 1 shifts: The number of times the sleep stage changed to stage 1.

Stage 2: The first true stage of sleep.

Stages 3/4: The deepest, most restorative sleep.

Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.

Supine: Sleeping on back.

Time in bed: The time in the study from `Lights Out' to `Lights On'.

Total arousal index: Total number of all arousals multiplied by the number of hours of sleep.

Total # of PLMs: The number of leg movements in sleep that last greater than 0.5 seconds.

Total sleep time: Total time asleep.

WASO: Wakefulness after sleep onset.

WNL: Within normal limits.
===========================================================================
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Re: How to read a sleep study test

Postby DreamStalker on Sun Nov 23, 2008 4:49 pm

So are you saying here were no obstructive apneas at all and that all were central?

If you have only central apneas, then I think they may not be treating you correctly.

Hopefully SD will come back to the thread and/or others will jump in to clarify.
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Re: How to read a sleep study test

Postby Snoredog on Sun Nov 23, 2008 5:42 pm

NOT unusual to see Central Apnea on your PSG, also not uncommon to see zero CA on your diagnostic PSG then them appear on the titration portion.

If you are not into guesses, put up a copy of said PSG report. If you have more than one, put up the first or diagnostic one then the final one.

It is not uncommon to see CA's on your PSG, it is what happens to them when you go on therapy.
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Re: How to read a sleep study test

Postby d.green on Wed Nov 26, 2008 10:32 pm

The PSG findings are as stated: During the all night titration the patient slept for 291 minutes out of 429 minutes of recording time for a sleep efficiency of 67.8%. Sleep latency was 11 minutes. REM latency was markedly prolonged at 389.5 minutes. Sleep consisted of stage 1,2,3,4 and REM sleep. Total REM sleep was decreased at 8.6% of total sleep time. Arousal index was 24.3 split equally between spontaneous arousals and those associated with respiratory events. The patient had this CPAP pressures of 5, 7, 9 and 10 used. He also had bilevel pressures of 14/10 up to 16/12. the best pressures were the CPAP pressures of 5,7 and 9. On all of these settings his Apnea Hypopnea Index was less than 5 and his RDI less than 8. The best pressure appeared to be 9cm where his RDI was 7.6. His supine RDI was also 7.6. On 7cm, his RDI was the same, but he had no supine sleep during that time. There was no REM sleep on any of these settings. Higher CPAP pressures and bilevel pressures appeared to induce central events. On 9cm CPAP, his mean oxygen saturation was 93% with a low of 87%. The Arousal Index was 24.2. He did use a Respironnics comfort gel full face mask, size medium.

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Re: How to read a sleep study test

Postby Snoredog on Thu Nov 27, 2008 12:04 am

d.green wrote:The PSG findings are as stated: During the all night titration the patient slept for 291 minutes out of 429 minutes of recording time for a sleep efficiency of 67.8%. Sleep latency was 11 minutes. REM latency was markedly prolonged at 389.5 minutes. Sleep consisted of stage 1,2,3,4 and REM sleep. Total REM sleep was decreased at 8.6% of total sleep time. Arousal index was 24.3 split equally between spontaneous arousals and those associated with respiratory events. The patient had this CPAP pressures of 5, 7, 9 and 10 used. He also had bilevel pressures of 14/10 up to 16/12. the best pressures were the CPAP pressures of 5,7 and 9. On all of these settings his Apnea Hypopnea Index was less than 5 and his RDI less than 8. The best pressure appeared to be 9cm where his RDI was 7.6. His supine RDI was also 7.6. On 7cm, his RDI was the same, but he had no supine sleep during that time. There was no REM sleep on any of these settings. Higher CPAP pressures and bilevel pressures appeared to induce central events. On 9cm CPAP, his mean oxygen saturation was 93% with a low of 87%. The Arousal Index was 24.2. He did use a Respironnics comfort gel full face mask, size medium.


The above was either a split-night study (first half diagnostic, 2nd half CPAP titration.

Use of CPAP indicates Obstructive Sleep apnea present where they tried pressure 5-10 cm and then Bipap at 14/10 up to 16/12, this means they tried the machine at various pressure and 9.0 cm seemed the best. However, your study is basically flawed because you did NOT reach any REM in the supine position, so the titration you are looking at is only an educated guess and may change dramatically once you use therapy for a a week or so.

If I were you, I would point this out to the doctor at next meeting and pretty much demand they give you an autopap so you can self-titrate at home. With the central phenotype present however they may be reluctant to do that, but that would not be a problem if the Sandman Auto was used.

CSDB possible:
If you did not have any centrals seen on your diagnostic portion of the study (before they put the mask on you) then the centrals showed up when you went on the xPAP machine, if your PSG shows any Mixed apnea (MA) then those "could be" traits of Complex Sleep Disordered Breathing (CSDB). This just means you have both obstructive and centrals phenotypes and that you may be intolerant of CPAP. And again, those centrals may go away and not be a problem at all, you will just have to see how you do.

So with the above, you have OSA and need a pressure of 9.0 cm to correct obstructive portion. However, until you reach REM sleep while on your back you won't know for sure if that 9.0 cm pressure is adequate to treat your OSA. If I was going to go for a machine based upon what I've seen above, I would only accept the Sandman Auto.

The Sandman Auto (and the 420e) have the better ability to differentiate obstructive from central and respond appropriately. Basically, it does the best job to report and avoid those centrals. Obstructive apnea you respond with pressure, when you have central apnea you don't want to respond. Some machines have difficulty making that distinction and will respond to central apnea which only makes them worse. From the machines perspective, a obstructive apnea lasting 40 seconds looks identical to a 40 second Central, in both there will be no airflow. The Sandman Auto differentiates those two by listening for Cardiac Oscillations heard from the open airway. It is a patented feature on the Sandman and 420e (Sandman is the replacement for the 420e).

A lot of the above is based upon your translated results, you may want to post a copy of your PSG as it will put things in better perspective.
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d.green
 
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Re: How to read a sleep study test

Postby d.green on Sun Nov 30, 2008 3:34 pm

I am unable to upload the file or picture of the report. Do anyone know how?

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Re: How to read a sleep study test

Postby DreamStalker on Sun Nov 30, 2008 4:07 pm

d.green wrote:I am unable to upload the file or picture of the report. Do anyone know how?



You need to set up an account at someplace you can upload and store your pictures like ... photobucket.com

Once you set up account and upload pics you can post here using the [IMG] tag when you make a post to the forum.
Thanks Snoredog, GoofyUT, rested gal, GoofProof, Wulfman, NightHawkeye, snoregirl and all of the others.
Thanks to Johnny and the fine members of CPAPTALK for helping me to discover my fountain of youth.
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Re: How to read a sleep study test

Postby OutaSync on Sun Nov 30, 2008 4:13 pm

Upload it to a free program like photobucket.com and then copy the url link and post it here.

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Re: How to read a sleep study test

Postby plr66 on Sun Nov 30, 2008 4:17 pm

DreamStalker wrote:
d.green wrote:I am unable to upload the file or picture of the report. Do anyone know how?



You need to set up an account at someplace you can upload and store your pictures like ... photobucket.com

Once you set up account and upload pics you can post here using the [IMG] tag when you make a post to the forum.

Yup, and if you're anything like me, it will just take several hours to figure out how to get the image from the card reader software into a pdf or a jpg in the appropriate program somewhere in the bowels of your computer, and then transferred successfully to photobucket...the free version of which does not apparently accept pdf's......and then never be able to repeat the process, much less recall to someone else how it is done..... :? :roll: :roll: :?

I know there have been a dozen explanations of this which might be found in a search, if my brain weren't so foggy today....There ARE LOTS of computer-smart folks here who can guide you through it step by step. Just be sure to be using jpg format. I think!! :lol:
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Re: How to read a sleep study test

Postby d.green on Sun Nov 30, 2008 6:24 pm

Here is a copy PSG report.Image
Last edited by d.green on Mon Dec 01, 2008 10:50 am, edited 2 times in total.

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ozij
 
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Re: How to read a sleep study test

Postby ozij on Mon Dec 01, 2008 4:53 am

Dan,
That was clearly a fulll nights titration study. Snoredog guessed wrong - he loves making those guesses.

The scatter of you events is much better at the lower, cpap pressure than at the higher, bipap. They must have moved to bipap when they tried to get rid of those residual Respiratory Disturbances.

We don't know why they couldn't - but at this point, if I were you, I'd concentrate on understanding my therapy at home.

You've got a great, automatic machine, they may even be using it to collect more data to help diagnose you. Can you see your results reported on the LCD? Can you keep track of them?

Some of us respond to higher pressures with central apnea - sort of reminds we of the way I suddenly stop breathing if I get into a very cold pool... some of us get used to having pressure blown in at us - and the central apneas diminish with time.

Here' a link explaining the term mentioned above: "complex sleep anpea" or "complex sleep disordered breathing - I'm not saying I think you have it - the does a good job of explain the other types as well. Bear in mind that its a PR video for a certain machine - but it teaches nonetheless.

Edit: forgot it insert the link, here it is:

http://www.vpapadaptsv.com/ResMed.htm

How are you feeling?
O.

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Last edited by ozij on Mon Dec 01, 2008 11:32 am, edited 1 time in total.
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Re: How to read a sleep study test

Postby d.green on Mon Dec 01, 2008 10:55 am

ozij wrote:Dan,
That was clearly a fulll nigths titration study. Snoredog guessed wrong - he loves making those guesses.

The scatter of you events is much better at the lower, cpap pressure than at the higher, bipap. They must have moved to bipap when they tried to get rid of those residual Respiratory Disturbances.

We don't know why they couldn't - but at this point, if I were you, I'd concentrate on understanding my therapy at home.

You've got a great, automatic machine, they may even be using it to collect more data to help diagnose you. Can you see your results reported on the LCD? Can you keep track of them?

Some of us respond to higher pressures with central apnea - sort of reminds we of the way I suddenly stop breathing if I get into a very cold pool... some of us get used to having pressure blown in at us - and the central apneas diminish with time.

Here' a link explaining the term mentioned above: "complex sleep anpea" or "complex sleep disordered breathing - I'm not saying I think you have it - the does a good job of explain the other types as well. Bear in mind that its a PR video for a certain machine - but it teaches nonetheless.

How are you feeling?
O.



I am still feeling tired and sleepy, I also wake up with a tired headache. I have put in a call to my doctor to see if something else can be done. Thanks again.


d.green

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Re: How to read a sleep study test

Postby ozij on Mon Dec 01, 2008 11:37 am

:oops: I was so busy checking that the link works that I forgot to insert it, here it is again:
http://www.vpapadaptsv.com/ResMed.htm

You're right about contacting your doctor. Are you sure they placed your machine on 9? If that's the machine you have in your profile, its a self adjusting one, aka an auto - and can be givern a range of pressures.

O.

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And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

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Re: How to read a sleep study test

Postby d.green on Mon Dec 01, 2008 11:52 am

ozij wrote::oops: I was so busy checking that the link works that I forgot to insert it, here it is again:
http://www.vpapadaptsv.com/ResMed.htm

You're right about contacting your doctor. Are you sure they placed your machine on 9? If that's the machine you have in your profile, its a self adjusting one, aka an auto - and can be givern a range of pressures.

O.


No, it was not set-up for me, so I left it on auto. I just set it to CPAP, with pressures between 7cm and 9cm. Here is what my numbers was last night.

Press: 10.8
Leak: 0.12
AHI: 10.9
AI: 0.8
HI: 10.1

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