Need Input Please

[Redsfan35]

This is the result of my sleep study from last week. I have been diagnosed as having moderate sleep apnea. I am in the process of finding a family doctor but I was wondering if some of the people here could fill me in on the following report because I understand very little of it. One question I do have is did I go periods of not breathing?? If so how many times and for how long??

Thanks






Letter of Interpretation
Polysomnogram
Patient History: a 41 year old male who is 71” tall and weighs 240 pounds. He has a neck circumference of 23”, and a BMI of 33. The patient reports a medical history of obesity, nose fracture, and seasonal allergies. The patient complaints include teeth grinding, waking with a sour/bitter taste, frequent night time urination, waking choking, gasping, short of breath, falling asleep unintentionally, loud snoring interrupted by silence/gasping, restless sleep, trouble concentrating, short temper, lack of energy, and fatigue. He has an Epworth Sleepiness Scale score of 7/24, and is not a user of tobacco products.
Medications: None.
Allergies: NKDA.
Day of Study:
Medications: None
Nap: None
Alcohol: None.
Caffeine: 6 Servings.
Protocol: This sleep study included the recording and monitoring of frontal, central, and occipital EEF, EOG, EMG, ECG, respiratory effort and flow, snoring, pulse oximetry, and position. Video recordings were obtained as needed. A qualified technician continually monitored patient throughout the night. Data was digitally stored and tabulated using Alice 5 software. Sleep staging and respiratory events were scored manually using AASM standards.
Position: The patient slept in the supine, left and right decubitus positions.
Sleep Latency: The patient’s sleep onset latency after lights out was 44.5 minutes. The Stage R sleep latency from sleep onset was 144.0 minutes.
Total Sleep Time: The total time in bed was 369.0 minutes with a total sleep time of 217.5 minutes. Sleep efficiency was 58.9%.
Sleep Architecture: The patient had 17.0 minutes of Stage R for 7.8% of TST, 30.5 minutes of Stage N1 for 14.0% of TST, 153.5 minutes of Stage N2 for 70.3% of TZST, and 17.0 minutes of Stage N3 for 7.8% of TST. The arousal index was 97.4 per hour of sleep.
Respiratory: The patient was observed to have had a total number of 229 apneas and hypopneas with an AHI index of 63.2 per hour during total sleep time. The Stage R AHI index was 31.8. The normal AHI index is less than 5 per hour. There were 40 obstructive apneas, 7 mixed apneas, 34 central apneas, 148 hypopneas, and 5 RERA’s. The total RDI (A/H + RERA’s) was 64.6. Loud snoring was noted for 75.2% of TST.
Oxygenation: The patient had an average oxygen saturation of 93%. The minimum oxygen level was 78%. Masimo Pulse Oximeters are accurate to a low SpO2 of 70% (+, -3).
Cardiac: The average heart rate was 64.0 beats per minute. The low heart rate during sleep was 532.0 beats per minute. The high heart rate during sleep was 78.0 beats per minute. The patient had a normal sinus rhythm with no arrhythmias noted.
Other/EMG: Patient had evidence of periodic leg movements during sleep. Patient had a total of 87 PLM’s with a PLM index of 24.0 and a total of 60 PLM arousals with a PLM arousal index of 16.6 per hour of sleep.
Diagnosis and Impressions: This PSF documented moderate OSA associated with severe O2 desaturation. No PLM noted.
Recommendation:
CPAP Titration
Weight Loss
Practice good sleep hygiene

[Babette]

"AHI index of 63.2 per hour"

Correct me if I'm wrong. I had an AHI of 60 and I was told I had SEVERE sleep apnea.

Where did you get your results from? Do you have a sleep doctor? If so, don't worry about getting a primary care (family) doctor at this time - just do everything with the sleep doctor. Try to find a sleep doc who is board certified, and if possible, a pulmonologist so you can see him/her for both your sleep apnea and your respiratory conditions.

Glad you found us so fast. You're a smart guy, and I think this process will be easier on you because you found us first.

Cheers,
B.

[PST]

You're one of us, Redsfan35. The history you gave reads like a textbook example of the kind of complaints that brought most of us to the doctor. When you put together things like waking up gasping, loud snoring, frequent nighttime urination (absent some other explanation), and falling asleep unintentionally during the day, there isn't much room for doubt.

In answer to your questions, apnea is the term used for a pause in breathing, and you had 81 of them over the course of about three and a half hours of sleep. The report doesn't say how long they were. They must each have been at least ten seconds, because that's part of the definition, and 30 seconds would be really long. They were long enough to cause your oxygen saturation to drop. This is a measure of how much oxygen blood carries. 100 percent is the theoretical maximum, with every hemoglobin molecule doing its job hauling oxygen. People vary, but 95ish is fairly normal. When your oxygen saturation drops into the 70s, that's significant. Basically, the two bad things sleep apnea does are interrupt normal sleep and cause those plunges in oxygen saturation. The other ill effects follow from those.

The doctor scored 40 of these apneas as obstructive, which is the kind where you try to breathe but your throat is closed and you choke and gasp a bit until you are sufficiently aroused from sleep to do so. He scored 34 as central apneas, in which breathing pauses for more than ten seconds but there is no respiratory effort. Seven were mixed obstructive and central. Central apneas can make treatment of obstructive apnea more complicated. It is something to talk to the doctor about.

An AHI of 63.2 measures the number of obstructive apneas and hypopneas per hour. Hypopneas are just partial obstructions, where the throat restricts airflow but some gets through. Like Babette, I'm pretty sure that an AHI of 63 is considered severe, not moderate. There are folks around here who've scored 100, though, so it's not severe-severe.

[SleepingUgly]

Cardiac: The average heart rate was 64.0 beats per minute. The low heart rate during sleep was 532.0 beats per minute. The high heart rate during sleep was 78.0 beats per minute.

Obviously "532.0" beats is a typo.

Other/EMG: Patient had evidence of periodic leg movements during sleep. Patient had a total of 87 PLM’s with a PLM index of 24.0 and a total of 60 PLM arousals with a PLM arousal index of 16.6 per hour of sleep.
Diagnosis and Impressions: This PSF documented moderate OSA associated with severe O2 desaturation. No PLM noted.

It says that you had PLMs and yet the diagnosis says no PLMs.

[BleepingBeauty]

If I remember correctly:

<5 AHI = normal, no OSA diagnosis
5-15 AHI = mild apnea
15-30 AHI = moderate apnea
30+ AHI = severe apnea

Severity has no impact on what your pressure needs might be. I was diagnosed with severe apnea (AHI of 107), and I need 12cms of pressure; someone else, diagnosed with mild apnea, might need a pressure of 18cms. Pressure needs are different for everyone.

Welcome to the forum, Redsfan. Start reading all you can here (before you obtain equipment), as your sleep study results indicate a potential need for a more sophisticated machine than a basic CPAP (i.e., one that can also treat central apneas, which occur when your airway is open but you make no effort to breathe; it's a neurological issue, and there are machines to treat it).


Glad to have you with us! Best of luck going forward.

[kteague]

From one Reds fan to another, welcome. Couple things I want to cosign with others on. Your case is not just the garden variety of OSA. Talk to the dcotor up front about how they handle such cases differently. You will want to be diligent with your followup and not adopt a wait and see way of dealing with your breathing issues. I'm sure others will give you some specific insights about what to be in tune to as you go forward with treatment. A titration study may clarify things a lot, once you see how you respond to cpap treatment.

Also, clarify about those PLMs and note on the titration study if they resolve or not. Sometimes they do, sometimes they don't. Just don't assume they will go away or don't matter, although they may go away and/or be insignificant.

[Redsfan35]

From one Reds fan to another, welcome. Couple things I want to cosign with others on. Your case is not just the garden variety of OSA. Talk to the dcotor up front about how they handle such cases differently. .

Thanks for responses everyone.

What exactly does it mean that my case is not just the garden variety of OSA?? Does that mean my case is out of the norm and of so how??

Also I am curious as to what step to take next. As of now I do not have a family doctor so I used a Med Check doctor to write me the subscription for the sleep study. The sleep study people told me once they get approval from the Med Check doctor then they can do another sleep study with a cpap mask on as soon as this weekend. They then told me depending on my insurance I may be able to take the mask and machine home that day which gave me the indication that after my second sleep study I would be done with them. I am curious, when should i meet a sleep doctor or should I meet one when I do the next sleep study?

[kteague]

Having a combination of obstructive, central, and mixed events MAY require handling a little differently. Maybe not. I have only obstructive type events, but having a combination is probably not rare, since others have posted similar results. I think it's going to take the titration study to give you a clearer picture. I would be hesitant to accept just any machine until you are clear that any concerns the titration reveals will be adequately addressed. It's rough that you are new at this without the guidance of a good physician who knows you well, but that shouldn't stop you from getting effective treatment. There are others on here who are experienced with your combination of issues who can answer questions as they arise. All I know is what I've gleaned here. While most general practitioners refer patients to specialists for sleep disorder management, I'm wondering if maybe a general practitioner might also be in order to evaluate you for any other possible medical conditions that may be in play.

I'm sure there's any number of Reds to be a fan of, but if by Reds fan that means Cincinnati Reds, I'm curious as to where you had your study. Most of the places in this area that I'm familiar with (4) have a sleep doctor affiliated with the facility. Ask where you had the study about that.

Best wishes.

Kathy

[ozij]

Having a combination of obstructive, central, and mixed events MAY require handling a little differently.

Another hint at that is the fact that your AHI in the REM stage is lower than the total AHI. It's the other way around in garden variety OSA.

Howevre, given the discrapancies on that report ("moderate OSA" for 63, "No PLM's" when PLM's are reported) I would do my utmost to get the raw data from the lab. You may eventaully want to have that scoring and diagnosis re-viewed by someone else.

Look to me like the person who wrote the report may have been somewhat sleep deprived too...

[Redsfan35]

I'm sure there's any number of Reds to be a fan of, but if by Reds fan that means Cincinnati Reds, I'm curious as to where you had your study. Most of the places in this area that I'm familiar with (4) have a sleep doctor affiliated with the facility. Ask where you had the study about that.

Best wishes.

Kathy

I went to Total Sleep Diagnostics In Indianapolis.


http://www.totalsleep.com/


Oh yes Cincinnati Reds fan here....loved the Chapman signing!!