Need Help Understanding Report

[nash1521]

My Husband has just been diagnosed with moderate obstructive sleep apnea with severe hypoxemia. We got the report and it sure is hard to understand. The diagnosis sounds bad to me but when my husband read the report he doesn't think it sounds bad enough to go to the cpap titration appointment I have set up for him. He had not been feeling well for several weeks and he went to the doctor and we found out he has high blood pressure. He is always tired, never feels rested even though he "sleeps" all night and naps during the day. After telling the doctor the list of complaints, including me telling the doctor about my husbands snoring, he was scheduled for the sleep study. My husband is not convinced getting a cpap machine will help. Any help in convincing him it is worth a try would be very much appreciated.

This is what his report says:

Total sleep time: 316.5
Sleep efficiency: 97%
Sleep latency: 4 minutes
REM latency: 76.5 minutes
Awakenings: 12
Wake time after sleep onset: 9 minutes
Total awake time: 13 minutes
Epworth Sleepiness Score: 13

Sleep Staging
N1: 28 minutes 6.7%
N2: 188 minutes 45.1%
N3: 132 minutes 31.7%
REM sleep: 68.5 minutes 16.4%

Arousal profile
total of 3 arousals index 0.4

Respiratory Data
Obstructive episodes: 144
no central apneas
no mixed apneas
Hypopneas were 50
Apnea/hypopneas 194
Anea/hypopnea index was 27.9

Oximetry data
Mean saturation awake was 94
REM sleep 93
Non-REM sleep 95
Lowest saturation seen was 61% with only 9.2 minutes spent with a saturation less than 90%

Summary Statement
Diagnostic polysomnogram revealing apnea/hypopnea index of 27.9
Sever hypoxemia seen with the lowest saturation seen at 61% but relatively short duration.

Snoring was loud during the study

Sleep efficiency was normal with no difficulty initiationg or maintaining sleep. Sleep staging showed some stage 3 sleep rebound. Decreased REM sleep compared to the expected.

IMPRESSION
1. Obstructive sleep apnea, moderate.
2. Hypoxemia, severe.
3. Sleep-related movement disorder, mild

RECOMMENDATIONS
1. CPAP titration
2. Weight loss
3. Emphasized good sleep hygiene with more consistent sleep rate patterns and eliminating naps





Any help deciphering this would be greatly appreciated. With these results will a cpap really help? Most confusing is the 97% sleep efficiency. Does that mean he is getting a good night sleep? if so why does he never feel rested? What does the rebound and latency and decreased REM sleep statements mean?
Thank you

[DavidE]

While there are others on this board with more in-depth understanding of all the numbers in your hubby's report, here's what jumps out for me. Basically, I would agree with the diagnosis of moderate obstructive sleep apnea. Why? There are two important numbers; one is his oxygen saturation level. That 9.2 mins. below 90% saturation is significant along with the lowest saturation all the way down to 61%. My understanding is that oxygen saturation should not be dropping below the high 90s or 90% as a lowest. I've learned that O2 saturation is a primary statistic looked at by sleep docs.

The second important number is Apnea/Hypopnea Index (AHI). The goal with CPAP is to get the AHI below 5. So, his 27.9 certainly does indicate a moderate problem.

From your post, the question seems to be whether he will do anything about going ahead with a sleep study and if so, will he then use a machine and mask during sleep. It seems to me that a person with sleep apnea must also have a desire to actively treat it, since so much depends on the patient's attitude to be willing to go through a sleep study and use the equipment nightly. I feel it takes an amount of determination/dedication, since there is an adjustment curve to using CPAP. One possible motivator is info about the health risks of not treating sleep apnea. My understanding is that not treating it means prolonging health risks which can include being plain dangerous.

[Pugsy]

Welcome to the forum. Will the use of cpap machine totally and completely eliminate the fact that your husband never feels totally rested no matter how much sleep he gets? In all honesty...unknown.
Will it help some? Very likely it will. Some people see a marked difference and others don't see an immediate huge positive response.

Why does he feel awful despite having a high sleep efficiency number? Because it isn't so much about quantity as it is about quality. His sleep quality is poor due to arousals from the apnea events and the oxygen levels dropping.
The body needs to go through the normal sleep stage cycles uninterrupted (or minimally interrupted) to have the best chance of utilizing the restorative powers of sleep. When sleep apnea events mess with the normal stages of sleep then they mess with the restorative powers of sleep.

You can read about normal sleep stages here. You can get an ideas as to what is normal. REM latency is how long it takes to get to REM stage. Normal is 90 to 120 minutes for the first stage.
http://en.wikipedia.org/wiki/Sleep

[Pugsy]

Oh, BTW Robysue has some explanations as to what the sleep study terminology means. See if it helps answer some of your questions. She has it documented in her blog here.
http://adventures-in-hosehead-land.blog ... -test.html

[nash1521]

Thank you for responding! Any input is much appreciated. I figure his recent diagnosis of Hypertension is a result of his sleep apnea so that is why I am hoping he follows thru so that he doesn't end up with the other side effects like heart attack or stroke. Thank you for the link to the blog, I will be reading that and having him read it too. He has read a lot of things on here the past few days that have answered a lot of his questions so thank you for such a great place to find answers!

[DoriC]

AHI= <15= Mild Obstructive Sleep Apnea
15-30= Moderate
>30 = Severe

I'm the spouse here too so I had to do some convincing early on, but now that he's seen the improvement in the quality of his life, he's a believer. Good luck and keep us posted.