Sleep Study Confusion

[ozij]

They diagnosed mild OSA because you had a Respiratory Distutrbance Index (RDI) of 8.7. The results prove that you are not sleeping well because you have breathing disturbances. That is more than you knew before that.

Your breathing interrupted your sleep 8.7 times an hour. Those disturbances were not bad enough to be called apneas, or hypopneas because you did not desaturate, but they did interrupt your sleep, cause your Excessive Daytime Sleepiness and you may be helped by cpap therapy.

http://www.aasmnet.org/Resources/Practi ... essure.pdf

The respiratory disturbance index (RDI) is used synonymously with
the apnea-hypopnea index (AHI) unless stated otherwise. Mild,
moderate and severe OSA are defined according to criteria used in
the accompanying review paper: Mild, 5 ≤ RDI ≤ 15; Moderate,
15 ≤ RDI ≤ 30; Severe, RDI > 30 episodes per hour of sleep.5

4.0 RECOMMENDATIONS
The following are recommendations of the Standards of Practice
Committee and the Board of Directors of the American Academy
of Sleep Medicine.
4.1.1 Treatment with CPAP must be based on a prior diagnosis of
OSA established using an acceptable method (Standard).
This recommendation is based on previous AASM practice
parameters for the indications for polysomnography and related
procedures (2005 update).1,2
4.1.2 CPAP is indicated for the treatment of moderate to severe OSA
(Standard).This recommendation is based on 24 randomized controlled
trials meeting Level I or II evidence-based medicine criteria
[3.1.7].6-29 Control procedures include sham-CPAP, placebo tablets,
conservative management, and positional therapy. Eight
studies were intention-to-treat designs.6,7,14,15,26-29 Only 1 study had
a power analysis18 and most studies were not truly double blind.
Most studies evaluated multiple outcomes and some trials had
negative results. Nonetheless, all 8 studies testing whether CPAP
significantly reduced sleep related respiratory events compared to
a control procedure had positive outcomes.8-10,17,19,23,28,29
4.1.3 CPAP is recommended for the treatment of mild OSA(Option).
This recommendation as an option is based on mixed results in
2 Level I30,31 and 3 Level II32-34 outcome studies in patients with
mild OSA [3.1.7].
4.1.4 CPAP is indicated for improving self-reported sleepiness in patients with OSA (Standard).
This recommendation is based on 10 randomized controlled trials6,9,13,15,16,18,24,25,33,35 in which CPAP reduced sleepiness more than control procedures in patients with OSA [3.1.3]. The Epworth
Sleepiness Scale was used in the vast majority of trials to assess
subjective sleepiness.

My emphasis added
Note the underlined text, and the red text .

There is nothing sloppy in the report. They're giving you a chance at an autotirtrating device instead of a sleep study, which can only be good, and everybody will have a much better picture of your sleep, and if your sleepiness and tiredness are resolved, all the better.

O.

[sleepyinO]

THANK YOU!!!

Thank you so much for providing that information. It makes me feel much better about the whole situation! I will try APAP and see if it helps.

[ozij]

You're very welcome, Brian. Keep us posted of how it goes.
Good luck
O.

[Slinky]

And I thank you too, Ozij! It was so good of you to post those article quotes. Shows to go you what we "patients" can sometimes misinterpret. I really got the impression when going over the linked report that it was purely 'puter software scored and generated - or a "sleep doctor" in some distant area had just inserted a word or comment here or there.

I'm really surprised you were given your raw data on your Polysomnogram, simply because you are not trained as to reading it properly. Your MD should have thoroughly gone over your sleep study results with you!!! You mentioned something about finding a Sleep Physician? Did you not see a Board Certified Sleep Physician prior to having a sleep study? Was this an accredited lab that you had your sleep study done in? Just judging by what is on your raw data, according to the lab I work in, we would not have issued CPAP. There are, however, a few things that are concerning with your results:

No REM Sleep (which could be due to some medications --- OR because of the "first night effect" of being in a sleep lab)

Now, this lack of REM Sleep.... You could very well have some form of OSA that is REM Related. This is an unknown.


The Educate on Sleep Hygiene statement.... that just means that you need to follow a routine before bed. No caffeine, no strenuous exercise,ect.

SleepTechy, I have read of a few sleep labs that do provide the full scored data summary report to the patient w/o their asking -at the time of a consultation w/the sleep doctor. Most of us, though, do have to request a copy. I ALWAYS want a copy BEFORE I see the doctor so I can form my questions and have them ready when I see him. I'm a slow thinker and always walk out of an appointment w/more questions than when I went in w/if I haven't had a chance to go over the report and "digest" the info before seeing the doctor.

My sleep lab almost lost me as a patient when their new sleep doctor wouldn't let them release the report to me before our appointment. He and I came to a "mutual understanding" at the very start of our appointment BEFORE we discussed ANYTHING ELSE.

Our local hospital I've used since a child (my mother worked there whilst I was growing up) lost me as a sleep lab patient because they changed from having sleep specialists on staff (one sleep neuro and 3 rotating sleep pulmo/critical care) to ONE contracted sleep pulmo who NEVER sees the patients but sends his dictated report to the referring doctor. He is available for consultation w/the referring doctor but NOT the patient. They also contracted out their radiologists and one can no longer schedule a procedure w/a particular radiologist because the hospital has no control over the radiologists' schedule. I no longer go there for my radiology procedures. (With Crohn's disease and COPD one gets to know the individual radiologists). They've also contracted out their anesthesiology and even the surgeons can NOT chose the anesthesiologist he prefers to work with. Several of the surgeons are NOT happy about this.

I was impressed that this sleep lab DID order an at home auto-titration, one of the things that made me go back and re-read the linked report. And I'm rather surprised that YOU didn't mention REGULAR SLEEP HOURS when you commented on the sleep hygiene. That appears to be the number 1 recommendation when discussing and explaining good sleep hygiene.

Look at the GOOD education forum members can get here that is so lacking from this country's sleep profession. You aren't the only sleep professional who drops in and contributes to these discussions and it is very much appreciated when members of the profession DO drop in and comment. Thank you, too.

[sleepyinO]

I just realized that I didn't even mention the one thing that the sleep tech told me the morning after my sleep study. (This was before he left the room and went back to the control center...then I had to go find him to ask if I was supposed to just leave or if I needed to do anything else.)

Anyway, he said that I grind my teeth (bruxism). I've already purchased a dental guard (those things are expensive!) and have managed to grind it down to nothing in about two weeks.

My point is:

Could this also be a contributing factor to my sleep issues, or is it just bad for your teeth?

I haven't wondered until now, why this information wasn't included in my sleep report...