Sleep study question

[mclosson]

I am 46 yrs old white male, 195 lbs, 6 foot 1.

Results:
Total recording time - 367 min
Total sleep - 275 min
Stage 1 - 41 min
Stage 2 - 233 min
Stage 3,4 - 0 min

Data - apneas and hypo

Number REM 0, NREM 44, Total events 10,
AHI vs. sleep stage - REM 0, NREM 9.6, total 9.6

AHI(tst) 9.6

Total - CA 0, OA10, MA 0, Total 10, HYP 34, RERA 6, total events 50 AHI 9.6, RDI 10.9
Index - 0, 2.2, 0, 2.2, 7.4, 1.3, 10.9

ECG stuff all ok

Arousal 89 total arousals or 19.5 per hour
29 awakenings

Resp. events - 10 obs apneas, 0 central apeas, 0 mixed apneas, 6 resp effort related apneas and 34 obs hypoapneas. Longest event 56 secs.

O2 - base 94%, lowest 83%, avg 93%, below 90 for 6.7 min.

No leg movement issues.

Moderate snoring

Recc. - Strongly recommend return for pos airway titration.

Doctor comments: Need CPAP, Did not get past stage 2 sleep, suspect it would be worse if in REM sleep.

I wonder if I really need machine based on this. I am tired alot and get very sleepy driving home. Seems to be mild case of APNEA and I am hesitant to go for follow up - any thoughts?

What led to test for apnea was a low testosterone level my endo suspects relationship to apnea.

Thanks

[Pugsy]

Stage 3,4 - 0 min

No restorative sleep stages to speak of.....

Resp. events - 10 obs apneas, 0 central apeas, 0 mixed apneas, 6 resp effort related apneas and 34 obs hypoapneas. Longest event 56 secs.

O2 - base 94%, lowest 83%, avg 93%, below 90 for 6.7 min.

significant length of event and Oxygen level drop.

Recc. - Strongly recommend return for pos airway titration.

Doctor comments: Need CPAP, Did not get past stage 2 sleep, suspect it would be worse if in REM sleep.

I wonder if I really need machine based on this. I am tired alot and get very sleepy driving home. Seems to be mild case of APNEA and I am hesitant to go for follow up - any thoughts?

Hmm, while "mild" by the technical definition, just the no restorative sleep stages should be enough to get you past denial. The events that you do have are significant enough to impact your overall quality of sleep. You aren't getting to the stages of sleep where your body regroups. How do you propose to fix that without giving cpap a try? If you were 80 years old maybe wouldn't need stages 3 and 4 so much but at your age, you definitely need it.

Do the titration study...

[ScrappinMom]

What led to test for apnea was a low testosterone level my endo suspects relationship to apnea.

Hmmmm...You sound a lot like my husband. He is about your age, height and weight, mild snoring, little to no REM, and has also been diagnosed with low testosterone. Has been on treatment but not getting the results that I had expected. I have suspected sleep apnea for him, but of course he thinks not. I have never heard of a relationship between LT and OSA.

Very curious to see if any one knows anything about this relationship.

Thanks.

[Handgunner45]

Very curious to see if any one knows anything about this relationship.

.

Cant say that I know anything about the relationship, however, I have been successfully treating my OSA for over 3.5 years, and was just recently diagnosed with low testosterone. Dr started me on transdermal testosterone and thinks that in about 3-6 months should be back to normal and not need them anymore. He thinks my system just needs a "kick start" to get things back on the right path. Time will tell. After 2 week already starting to see some improvements...not as run down at the end of the day.

[Pugsy]

I have suspected sleep apnea for him, but of course he thinks not. I have never heard of a relationship between LT and OSA.

Googled low testosterone and sleep apnea, lots to read about, small sampling below. If my husband were your husband I would likely let him try my machine one night at minimal pressures just to see what numbers showed up... But that is just me. Ideally, he needs to be checked the full way if he has any other symptoms of OSA....

http://www.seekwellness.com/andropause/ ... -risks.htm
"Various studies have shown that testosterone treatment may worsen pre-existing sleep apnea.5 Others have shown that some men with sleep apnea have low testosterone levels that normalize when the sleep apnea is treated.6 Obviously, the relationship between testosterone and sleep apnea is still poorly understood. In any case, if you have sleep apnea, you should discuss treatment for this condition with your doctor before you try testosterone replacement therapy."

http://www.apneasupport.org/post-4534.html
Article from the American Technion Society, 2002:
Quote:

Decreased Testosterone Levels Linked To Sleep Disorder
July 25, 2002


Sleep apnea is a respiratory disorder that affects 4%-9% of adult males. Its most common manifestation is loud snoring and it may occur several hundred times throughout the night, resulting in sleep fragmentation and excessive daytime sleepiness. The current study, reported in the July issue of The Journal of Clinical Endocrinology & Metabolism, found that nearly half the subjects who suffered from severe sleep apnea also secreted abnormally low levels of testosterone throughout the night.

HAIFA, ISRAEL and NEW YORK, NY, July 25, 2002-Male patients who suffer from obstructive sleep apnea (OSA) -- the inability to breathe properly during sleep -- produce lower levels of testosterone, resulting in decreased libido and sexual activity, according to researchers at the Technion-Israel Institute of Technology. Previous studies had indicated that male sleep apnea patients had reported decreased libidos but the studies were unable to establish a scientific link. The current study, reported in the July issue of The Journal of Clinical Endocrinology & Metabolism, found that nearly half the subjects who suffered from severe sleep apnea also secreted abnormally low levels of testosterone throughout the night.

"For years we have seen sleep-disorder patients complain of decreased libido but we had no explanation for this phenomenon until now," said Professor Peretz Lavie, head of the Technion Sleep Laboratory and study leader.

Sleep apnea is a respiratory disorder that affects 4%-9% of adult males. Its most common manifestation is loud snoring and it may occur several hundred times throughout the night, resulting in sleep fragmentation and excessive daytime sleepiness. For many years sleep apnea sufferers have complained of decreased libidos, yet previous studies reported that patients' testosterone levels, although low, were within the normal adult male range.

The current study adopted a different methodology. Earlier studies had only measured participants' testosterone levels once after awakening. In this study, subjects were admitted to the Technion Sleep Center for an entire night and were fitted with electrodes and catheters. They were monitored between 7 p.m. and 7 a.m. with blood samples collected every 20 minutes. At 10 p.m., lights were turned off and the participants retired to sleep. Two groups -- one of sleep apnea patients and another of normal controls of similar body weight and age -- were investigated.

The study found that nearly half the sleep apnea patients secreted abnormally low testosterone levels throughout the night. ..........."

[ScrappinMom]

Thanks Pugsy!! I will definitely do some more reading. I'm not sure I want to give him my machine for a night but I do have a recording oximeter. Might try that first and see what it shows and go from there. Not sure I could even get him to use my machine! At least it is another path to pursue.

[Pugsy]

I'm not sure I want to give him my machine for a night but I do have a recording oximeter. Might try that first and see what it shows and go from there. Not sure I could even get him to use my machine!

My husband has to pee often during the night. Age 60 so we had prostate checked, supposedly okay. I keep offering my machine and he keeps pooh poohing me off. This is from the man that pushed me to get tested...and sees the improvement. So there is no treatment for being hard headed except my 2 X 4 which may need to be used.

Pulse oximetry would be a good easy alternative, bear in mind that while significant desats could be diagnostic the absence of desats doesn't mean no OSA. Some people with OSA do not have significant oxygen level drop.

[ScrappinMom]

Pugsy, yes mine has worn a path to the bathroom, also. And yes, he flat out told me he does not have OSA, and yes, he is the one that nagged me to death to get a sleep study done for myself. Might have to bring out my own 2x4
I was thinking that if the pulseox showed desats, that might nudge him to consider I might be right! Well...maybe not, but it's worth a try!

[Pugsy]

I was thinking that if the pulseox showed desats, that might nudge him to consider I might be right! Well...maybe not, but it's worth a try!

It is worth a try, just be aware that if there aren't any significant O2 drops, then he will have ammunition that he doesn't have OSA to use against you. I don't know the official numbers of people with OSA that don't desat, I just know that the absence of a desat doesn't automatically mean you don't have OSA. Of course if he does have some big desats then you get to do the "I told you so" routine...

We tested my brother in law (and my sister) with my auto unit set at minimal pressures just to see what would happen. My sister has all the classic symptoms and pretty much came up with nothing to get greatly excited about. A handful of flow limitations and hypopneas and that was it. BIL was a different story and the only symptom he really exhibits is mild snoring. He definitely has OSA but has yet to see the "light" about just how significant this really is. Looks like we may need a third 2 X 4....

[ScrappinMom]

mclosson, Sorry, I didn't mean to hijack your thread. I'll get it back on track now. I agree with Pugsy, go for the titration. That you are tired a lot and get sleepy driving home is reason enough. Plus add in 89 arousals w/ 29 awakenings, and no stage 3/4/REM sleep. Your brain essentially woke up 89 times in about 4.5 hours and never got to recuperative sleep.

[millich]

Mclosson -

I would suggest that you go for the titration study. See what results you get then before you decide whether or not you actually want to pursue CPAP. Sleep apnea tends to be worse during REM sleep so it may be that, if you fall into deeper stages of sleep, your numbers may be worse. IMHO, your numbers and symptoms are bad enough now to do a trial on CPAP.

Interestly, my sleep doc said at my last appointment that the severity of symptoms (and the relief on CPAP) aren't always tied to the severity of sleep apnea. He says sometimes those with mild/moderate sleep apnea feel as bad as those with severe apnea. One of these days, I'm going to do a poll about this.

Go for the titration and let us know what you find out!